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Government of India

Ministry of Electronics & Information technology


Separate GeM NATIONAL INFORMATICS CENTRE
Requistion A-Block, CGO Complex, Lodhi Road, New Delhi- 110 003
form Required for
GeM Requisition Form
Each OEM
File FTS No. :-

1 Item Name and Description

UPS System for AMC


2 Specification
(You may attach additional that for detailed OEM NAME
specification as on GeM, if available on GeM)
3 Available on GeM/Not Available
Yes
4 Quantity 5KVA=3, 10KVA=2 etc.
( List attached)
5 Attach PAC, (If required).
(format can be downloaded from Intranic – Yes / No
Purchase)
6 Terms & conditions, Specific to items As per NIC HQ
7 Consignee Contact Details, Name, Address ,
State/District, e-mail etc.
officer form state HQ
8 Contact Details of Member Convenor
Infrastructure /
Store Incharge
9 Contact Details of Co-opted member from
specialised Group Might be leave blank

 Attach extra sheet wherever, it is required.


 Please ensure that Consignee is Registered on GeM Portal through Nodal Officer.

Signature of User Infrastructure Head/ Signature of HOD/HOG/SIO


Name: Store Incharge Name:
Designation: Designation:
Group/Div. / State Unit

HOG(Store)

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