Tender for Purchase of Cloth Cotton Drill Khaki - Central Reserve ...
Tender for Purchase of Cloth Cotton Drill Khaki - Central Reserve ...
Tender for Purchase of Cloth Cotton Drill Khaki - Central Reserve ...
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APPENDIX‐ “A”<br />
OFFICE OF THE DY. INSPECTOR GENERAL OF POLICE, GC CRPF,<br />
MOKAMAGHAT, PATNA (BIHAR)- 803303.<br />
(Telephone/Fax No. 06132-232412)No. L.VII-3/2012-13-GC(S)MKG (<strong>Cloth</strong> <strong>Drill</strong>)<br />
Dated, the 04Aug.’ 2012.<br />
<strong>Tender</strong> Notice(Cost <strong>of</strong> <strong>Tender</strong>: Rs. 250-00(Rupees Two<br />
hundred fifty only)(As contained in DGS&D manual chapter 8.7)<br />
Sealed tenders are invited from reputed firms on behalf <strong>of</strong> the president <strong>of</strong> India<br />
<strong>for</strong>favour <strong>of</strong> DIGP, GC CRPF, Mokamaghat, Patna (Bihar) 803303 in two bid system (Technical<br />
and Price bid) <strong>for</strong> purchase <strong>of</strong> the following quantity <strong>of</strong> <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong>. Details as under<br />
:-<br />
S/No. Description <strong>of</strong> Stores Total Qty<br />
01. <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong><br />
Specification :- Shade : <strong>Khaki</strong>, Width (cms) : 71 cms.<br />
(Mercerized & Pre-Shrunk quality) con<strong>for</strong>ming to variety<br />
No. 4, <strong>of</strong> specification No. IS: 177-1989 (4 th revision<br />
with amdt. No. 1 & 2 (RA-2008) as per details given in<br />
technical requirements in width excluding selvedge.<br />
71,525 Mtrs.<br />
Earnest Money required : Rs. 1,20,000-00<br />
Date & Time <strong>of</strong> receipt <strong>of</strong> <strong>Tender</strong>s : Till 06/09/2012 at 1400 Hrs.<br />
Date & Time <strong>of</strong> Opening the <strong>Tender</strong>s : On 07/09/2012 at 1100 Hrs.<br />
INSTRUCTIONS:-<br />
1. SAMPLE:- All bidders are required to display and submit sample <strong>of</strong> <strong>Cloth</strong> <strong>Cotton</strong><br />
<strong>Drill</strong> <strong>Khaki</strong> minimum 01 Mtr. alongwith its connected documents. The successful bidders shall<br />
be required to sendTwelveNos. <strong>of</strong> advance samples to this GC <strong>for</strong> further dispatch to all<br />
consignees.<br />
2. DELIVERY:- <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> should be supplied within 60 days after issue<br />
<strong>of</strong> supply order. If supply <strong>of</strong> store is not found as per specification/sample complete lot will be<br />
rejected at the risk and cost <strong>of</strong> the supplier. Rejected items must be replaced by the supplier<br />
within delivery period.<br />
3. DESPATCH/F.O.R. :- <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong>will be Free Delivered to the<br />
following consignee at freight, risk and cost <strong>of</strong> the supplier :-<br />
Continued to page No.(2)
:: 2 ::<br />
Details <strong>of</strong> Consignee’s<br />
Sl. No. Name & Address <strong>of</strong> Consignee’s Total Qty.<br />
1. The DIGP, Group Centre, CRPF, Mokamaghat, Patna (Bihar) 18,618 Mtrs.<br />
2. The DIGP, Group Centre, CRPF,Jhapha,Muzaffarpur (Bihar) 2394 Mtrs.<br />
3. The DIGP, Group Centre, CRPF, Ranchi (Jharkhand) 1745 Mtrs.<br />
4. The DIGP, Group Centre, CRPF, Rampur (Jharkhand) 20795 Mtrs.<br />
5. The DIGP, Group Centre, CRPF, Lucknow (U.P.) 626 Mtrs.<br />
6. The DIGP, Group Centre, CRPF, Amethi (U.P.) 5532 Mtrs.<br />
7. The DIGP, Group Centre, CRPF, Kathgodam (U.P.) 2331 Mtrs.<br />
8. The DIGP, Group Centre, CRPF, Durgapur (W.B.) 772 Mtrs.<br />
9. The DIGP, Group Centre, CRPF, Bhopal (M.P.) 227 Mtrs.<br />
10. The DIGP, Group Centre, CRPF, Gwalior (M.P.) 7530 Mtrs.<br />
11. The DIGP, Group Centre, CRPF, Neemuch (M.P.) 5217 Mtrs.<br />
12. The DIGP, Group Centre, CRPF, Bilaspur (Chhatisgarh) 5738 Mtrs.<br />
4. PAYMENT TERMS :-Payment will be recouped through FVC Bill on receipt <strong>of</strong><br />
complete supply <strong>of</strong> <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> & final Bill. in triplicate Payment will be<br />
made through ECS.<br />
5. PACKING:- Packing should be done in as per instruction and IN DESIRED Condition.<br />
6. TWO BID SYSTEM :-<br />
<strong>Tender</strong> will be processed in Two Bid System and to be submitted as follows :-<br />
The Technical as well as the PRICE BID must be enclosed in different envelop and<br />
both the envelop should be separately sealed and super scribed with the Technical Price Bid,<br />
<strong>Tender</strong> No. & Date <strong>of</strong> Opening in the Red Ink. The two separate evnvelops should<br />
thereafter, be kept in one envelop which should be properly sealed. The cover should also be<br />
super scribed with the TENDER NO. & DATE OF TENDER OPENING.<br />
7. TECHNICAL BID :-<br />
Technical Bid should contain :-All <strong>Tender</strong> documents duly completed and signed but<br />
without indicating the rates quoted.<br />
1. Copy <strong>of</strong> registration certificate with DGS&D/NSIC/SSI if any.<br />
2. Copy <strong>of</strong> registration <strong>of</strong> firm.<br />
3. Copy <strong>of</strong> last year VAT/Sale Tax Returns or certificate.<br />
4. Earnest Money deposited in Original D.D. or B.C.<br />
5. Copy <strong>of</strong> Lab test Report which will be carried out from Govt./Authorised laboratory<br />
approved by NABL in Original.<br />
6. Copy <strong>of</strong> manufacturer or authorization letter/certificate.<br />
7. Details <strong>of</strong> Supply order placed recently/Past per<strong>for</strong>mance <strong>for</strong> <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong><br />
<strong>Khaki</strong> if any.<br />
8. Photocopy <strong>of</strong> Pan Card (Firms or supplier) should be attached with <strong>Tender</strong><br />
Documents.
:: 3 ::<br />
9. FOR : At mentioned consignee place the delivery period should be less than 60<br />
days after confirmation <strong>of</strong> Supply order must be mentioned.<br />
10. Rate quoted by the firms should be on firm price basis. The rates will remain same<br />
till 06 months.<br />
11. Any other relevant documents which firm wish to submit.<br />
8. Price Bid :-<br />
Price bid should contain:-<br />
1. Details <strong>of</strong> Price, Taxes, duties and discount if any, to be quoted clearly by the<br />
bidders on their letter pad.<br />
2. Rates must be written in figures as well in words clearly.<br />
3. There should not be any cutting/overwriting. If by any change there is any over<br />
writing/cutting then a line should be drawn through the entire figure/word canceling<br />
the same and the word/figure should be freshly re-written and initialed by the<br />
tenderer.<br />
Note:- <strong>Tender</strong>s received in the single Bid System i.e. Having the Technical as well<br />
as financial bid in the same cover will be liable to be ignored.<br />
Incomplete/wrong technical bids/will also result in rejection <strong>of</strong> the bid.<br />
The Following in<strong>for</strong>mation should be specifically given :-<br />
(a) The proposed items are being purchased only on credit basis. The payment will be<br />
made to firm only on recoupment <strong>of</strong> bill.<br />
(b) <strong>Tender</strong>er should mention that business dealing with their firm have not been banned<br />
by any Govt./Private agencies.<br />
(c) <strong>Tender</strong>s documents duly completed in all respect are to be submitted by<br />
Registered/Speed Post/Courier in favour <strong>of</strong> The DIGP, GC CRPF, Mokamaghat,<br />
Patna (Bihar) 803303 be<strong>for</strong>e due date, late/delayed tenders shall not be opened<br />
and returned as such to tenderer.<br />
9. Conditions regarding deposit <strong>of</strong> Earnest Money:-<br />
(1) All firms that are not specially registered with NSIC or DGS&D <strong>for</strong> the supply <strong>of</strong><br />
<strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> <strong>for</strong> which the <strong>of</strong>fers are invited, are required to deposit<br />
Earnest Money as mentioned in the <strong>Tender</strong> Schedule.<br />
(2) Earnest Money D.D. or B.C. should be payable at SBI, Aunta, Mokamaghat, Distt.-<br />
Patna (Bihar) code- 6612 in favour <strong>of</strong>f the DIGP, GC CRPF, Mokamaghat, Patna(Bihar)<br />
803303.<br />
(3) EMD <strong>of</strong> unsuccessful tenderers shall be returned by the purchaser as early as possible,<br />
However, no interest shall be paid by the purchaser on the EMD deposited by the<br />
tenderer.<br />
(4) The successful firm will have to make security deposit <strong>of</strong> 10% <strong>of</strong> the cost <strong>of</strong> stores<br />
within 15 days <strong>of</strong> the placement <strong>of</strong> supply order <strong>for</strong> due per<strong>for</strong>mance as per provisions<br />
contained in Clause 7 <strong>of</strong> DGS&D- 68 (Revised). After depositing <strong>of</strong> per<strong>for</strong>mance security<br />
the EMD will be returned.
:: 4 ::<br />
(5) The earnest money deposited is liable to be <strong>for</strong>feited if the tenderer withdraws <strong>of</strong><br />
amends, impairs or derogate from the tender in any respect within the period <strong>of</strong> validity<br />
<strong>of</strong> his tender.<br />
(6) If the tenderer(s) failed to supply the <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> within stipulated period<br />
(unless extended), the security money will be <strong>for</strong>feited. No. extension in D.P. shall be<br />
entertained without L.D. which shall be charged @ 2% <strong>of</strong> the value <strong>of</strong> delayed supplies<br />
per month.<br />
10. <strong>Purchase</strong>r reserves the right to get the manufacturing capacity <strong>of</strong> all firms re-verified<br />
irrespective <strong>of</strong> the registration status.<br />
11. <strong>Purchase</strong>r reserves the right to cancel/reject or scrap the tender without assigning any<br />
reason at any stage.<br />
12. <strong>Tender</strong>s are available at WEB Site :“ www.crpf.gov.in.”and The DIGP, GC CRPF,<br />
Mokamaghat, Patna (Bihar) against Payment. All tenders to submit tender fee <strong>for</strong> Rs. 250/-<br />
(Non refundable) through demand draft drawn in favour <strong>of</strong> The DIGP, GC CRPF,<br />
Mokamaghat, Patna (Bihar) payable at SBI, Aunta, Mokamaghat, Patna (Bihar) Code-<br />
06612. In case tenderers are submitting down loaded tender documents they must enclosed<br />
demand draft <strong>for</strong> Rs. 250/- alongwith Technical bids, and should not be included with<br />
Earnest Money, failing which tender shall be summarily rejected.<br />
13.TENDER SAMPLE REQUIREMENT:-<br />
1. All bidders are required to submit <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong>samples minimum 1 Mtr.<br />
As per specification mentioned in tender along with indicating manufacturing.<br />
2. Offers received without tender samples or in case <strong>of</strong> tender samples are received after<br />
the due date and time <strong>for</strong> receipt <strong>of</strong> tenders shall be ignored summarily.<br />
3. The price bid <strong>of</strong> eligible firms will be opened and order would be considered on the<br />
Good quality Sample and lowest bidders subject to their capacity and per<strong>for</strong>mance etc.<br />
4. All tender samples should have duly signed and stamped by the firm.<br />
5. <strong>Purchase</strong>r reserve right to increase or decrease the quantity at any stage.<br />
6. The items should be thoroughly tested by leading any <strong>of</strong> the laboratories approved by<br />
NABI. Must submit the lab test certificate in original along with their technical bid. The<br />
Lab test certificate should indicate that:-<br />
“ It is certified that the tender sample <strong>of</strong>fered <strong>for</strong> lab test is meeting/not<br />
meeting all the requirements <strong>of</strong> the governing specifications <strong>for</strong> the quoted<br />
items and the sample is acceptable/not acceptable with reference to its<br />
governing specifications i.e. <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> Width- 71 cms”.<br />
(Note: Deletes whichever is not applicable.<br />
Signature and seal <strong>of</strong> the Lab.
14. LIQUIDATED DAMEGE:-<br />
:: 5 ::<br />
In case the firm does not complete the supply within delivery period the purchaser<br />
reserve the right to either extend further or cancel the contract.<br />
15. The Competent Authority shall be final authority Regarding Acceptance/Rejection <strong>of</strong> the<br />
tender and increase/decrease <strong>of</strong> the quantity <strong>of</strong> the <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> and any<br />
other matter per<strong>for</strong>ming to refund the security/Earnest Money.<br />
16. Be<strong>for</strong>e submission <strong>of</strong> tender, tenderers will check attached to this <strong>Tender</strong> Documents as<br />
Appendix – A to F <strong>for</strong> compliance on various stipulations <strong>of</strong> the tender.<br />
Sd- 04/08/2012<br />
(RAJ KUMAR) DIGP,<br />
GC CRPF, MOKAMAGHATFOR AND ON BELHALF OF<br />
THE PRESIDENT OF INDIA
To,<br />
:: 6 ::<br />
APPENDIX-“B”<br />
TECHNICAL BID FORM SUBMITTING TENDER<br />
The DIGP,<br />
Group Centre, CRPF, Mokamaghat, Patna (Bihar) 803303.<br />
Reference:- Your tender notice No. L.VII-3/20121-13-GC(S) (<strong>Cloth</strong> <strong>Drill</strong>) dated<br />
___/07/2012.<br />
Sir,<br />
I hereby <strong>of</strong>fer to supply the <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong> given in schedule and agree<br />
to hold <strong>of</strong>fer open till ……./…./2012. I shall be bound by a communication <strong>of</strong> acceptance within<br />
the prescribed time.<br />
2. I have understood the terms and conditions as laid down in Para 1 to 17 and<br />
certify that I will be fully abide by terms and conditions. If I/We fail to comply with any <strong>of</strong> the<br />
terms and conditions EMD/Security Money already deposited may be <strong>for</strong>feited.<br />
3. Rs. …………………/- (Rupees ………………………………………………) only as EMD<br />
enclosed herewith in <strong>for</strong>m <strong>of</strong> DD/BC No. ……………………………. Dated ………………..issued by<br />
Bank.<br />
4. Certified that I have no pre-conditions attached with tender.<br />
Signature,<br />
Your’s faithfully<br />
Name <strong>of</strong> tenderer,<br />
Address with seal.
To,<br />
APPENDIX-“C”<br />
:: 7 ::<br />
PRICE BID FORM FOR SUBMITTING TENDER<br />
The DIGP,<br />
Group Centre, CRPF,<br />
Mokamaghat, Patna (Bihar) 803303.<br />
Reference:- Your <strong>Tender</strong> notice No. L.VII-3/2012-13-GC(S)MKG (<strong>Cloth</strong> <strong>Drill</strong>) dated<br />
/07/2012.<br />
Sl. No. Name <strong>of</strong> Items Qty. Rates<br />
01. <strong>Cloth</strong> <strong>Cotton</strong> <strong>Drill</strong> <strong>Khaki</strong><br />
Specification :- Shade : <strong>Khaki</strong>, Width (cms) : 71 cms.<br />
(Mercerized & Pre-Shrunk quality) con<strong>for</strong>ming to variety<br />
No. 4, <strong>of</strong> specification No. IS: 177-1989 (4 th revision<br />
with amdt. No. 1 & 2 (RA-2008) as per details given in<br />
technical requirements in width excluding selvedge.<br />
01 Mtr.<br />
VAT/CST ___________________<br />
Your’s faithfully<br />
(Signature <strong>of</strong> <strong>Tender</strong>er)<br />
Address with seal.
:: 8 ::<br />
APPENDIX-“D”(<strong>Tender</strong>ers<br />
should check following requirements <strong>for</strong> compliance be<strong>for</strong>e submission <strong>of</strong> the<br />
tender documents)<br />
Sl. No. Requirements to be checked by the tenderers be<strong>for</strong>e<br />
submission <strong>of</strong> the tender.<br />
01. <strong>Tender</strong>ers should mention quantity <strong>for</strong> which they have quoted.<br />
This should be mentioned in the covering/<strong>for</strong>warding letter head <strong>of</strong><br />
the technical bid.<br />
02. <strong>Tender</strong>ers should ensure deposit <strong>of</strong> required earnest money<br />
Deposit if the tenderers are not registered with DGS&D /NSIC <strong>for</strong><br />
the store(s) quoted <strong>for</strong> the governing specification as per <strong>Tender</strong><br />
Enquiry.<br />
03. <strong>Tender</strong>ers should ensure that their registration with DGS&D and<br />
NSIC and not depositing Earnest Money. They should enclose the<br />
latest DGS&D/NSIC registration certificate.<br />
04. <strong>Tender</strong>ers should confirm that their equipment/products con<strong>for</strong>m<br />
to the governing specifications <strong>of</strong> the quoted stores as per <strong>Tender</strong><br />
Enquiry.<br />
05. <strong>Tender</strong>ers should mention whether it is an SSI Unit or not.<br />
06. <strong>Tender</strong>ers should mention their monthly manufacturing supplying<br />
capacity.<br />
07. <strong>Tender</strong>ers should mention in <strong>Tender</strong> enquiry that they accept our<br />
delivery terms i.e. They agree to supply stores at consignees<br />
location at freight, risk and cost <strong>of</strong> the tenderers.<br />
08. <strong>Tender</strong>ers should mention that their <strong>of</strong>fer is valid up to 180 days<br />
from the date <strong>of</strong> opening <strong>of</strong> the tender.<br />
09. <strong>Tender</strong>ers should mention their delivery period clearly.<br />
10. <strong>Tender</strong>ers should mention that they agree to the Tolerance Clause<br />
<strong>of</strong> the <strong>Tender</strong> Enquiry.<br />
11. <strong>Tender</strong>ers should give their past per<strong>for</strong>mance in the specified<br />
<strong>for</strong>mat given in the <strong>Tender</strong> documents.<br />
12. <strong>Tender</strong>ers should mention that they agree to the arbitration clause<br />
<strong>of</strong> the <strong>Tender</strong> Enquiry.<br />
13. <strong>Tender</strong>er must ensure that the Lab test report along with clear<br />
verdict certificate required as per Clause- 19.1 <strong>of</strong> Schedule to<br />
<strong>Tender</strong> Enquiry documents is enclosed.<br />
14. <strong>Tender</strong>ers must ensure that the counter Sample (remnant portion<br />
<strong>of</strong> the test sample) duly scaled, Stamped and signed by the Lab<br />
should be attached with the <strong>Tender</strong> Sample/Lab test report.<br />
15. <strong>Tender</strong>ers should mentioned whether it is the manufacturer <strong>of</strong> the<br />
store(s) quoted or it is the manufacturer’s authorized agent. In<br />
case <strong>of</strong> agent, it should submit valid authority letter(s) <strong>of</strong> their<br />
Principal(s) <strong>for</strong> the stores they have quoted.<br />
16. <strong>Tender</strong>ers should mention that Business dealing with their firms<br />
has not been banned by any Govt./Private agencies.<br />
17. <strong>Tender</strong>ers should ensure to sign each page <strong>of</strong> the <strong>Tender</strong><br />
documents with name, designation, seal and address <strong>of</strong> the<br />
signatory.<br />
18. If the tenderers want to mention any specific condition, it should<br />
be mentioned on the covering/<strong>for</strong>warding letter only which will be<br />
placed on the first page <strong>of</strong> the technical bid. Such condition<br />
mentioned in any other document shall not be given any<br />
consideration.<br />
19. <strong>Tender</strong>ers should mention their address <strong>for</strong> communication with<br />
Telephone and Fax Number.<br />
Compliance (To be indicated<br />
by the tenderer with “YES”<br />
after compliance <strong>of</strong> the<br />
requirements)<br />
Signature <strong>of</strong> the <strong>Tender</strong>er.
:: 9 ::<br />
Per<strong>for</strong>mance Statement <strong>for</strong> Last Year.<br />
APPENDIX-“E”<br />
Name <strong>of</strong> Firm :- ________________________________________________<br />
1. Contract/Supply Order No. :-<br />
2. Description <strong>of</strong> Stores :-<br />
3. Quantity <strong>of</strong> Order :-<br />
4. Value :-<br />
5. Original D.P. :-<br />
6. Qty. supplied within Original D.P. :-<br />
7. Final Ext. D.P. :-<br />
8. Last supply position :-<br />
9. Reasons <strong>for</strong> Delay in Supplies :-<br />
(If any)<br />
Signature <strong>of</strong> the <strong>Tender</strong>er.
:: 10 ::<br />
APPENDIX-<br />
“F”PROFORMA FOR BANK GAURANTEE FOR SUBMITTING EARNEST MONEY<br />
(ON BANKS LETTER HEAD WITH ADHESIVE STAMP)<br />
To,<br />
PRICE BID FORM FOR SUBMITTING TENDER<br />
The DIGP,<br />
Group Centre, CRPF,<br />
Mokamaghat, Patna (Bihar) 803303.Dear Sir, In accordance with your<br />
invitation to <strong>Tender</strong> No. L.VII-3/2012-13-GC(S)MKG(<strong>Cloth</strong> <strong>Drill</strong>) dated ___ /07/2012, M/S,<br />
______________________________ here in after called the <strong>Tender</strong>er with the following<br />
Directors on their Board <strong>of</strong> Directors/Partners <strong>of</strong> the firm.<br />
1.____________________________ 2.__________________________________<br />
3.____________________________ 3.__________________________________<br />
Wish to participate in the said tender enquiry <strong>for</strong> the supply <strong>of</strong>_______________________as a bank<br />
guarantee against Earnest Money <strong>for</strong> a sum <strong>of</strong> Rs.__________ (in<br />
word)____________________________ valid <strong>for</strong> 240 days from the date <strong>of</strong> tender opening viz to up to<br />
_______________________ is required to be submitted by the <strong>Tender</strong>er as condition <strong>for</strong>the participation,<br />
this bank hereby guarantees and undertakes during the above said period <strong>of</strong> 180 days to immediately<br />
pay on demand by _______________ in the amount <strong>of</strong> without any reservation and recourse if.<strong>Tender</strong>er<br />
after submitting his tender, modifies the rates or any <strong>of</strong> the terms and conditions there<strong>of</strong>, except with the<br />
previous written consent <strong>of</strong> the purchaser.<br />
1. The <strong>Tender</strong>er withdraws the said tender within 180 days after opening <strong>of</strong> tenders OR,<br />
2. The <strong>Tender</strong>er having not withdrawn the tender, fails to furnish the contract security deposit<br />
imposed <strong>for</strong> due per<strong>for</strong>mance <strong>of</strong> the contract within the period provided in the general<br />
conditions <strong>of</strong> the contracts.<br />
The guarantee shall be irrevocable and shall remain valid up to ______________ if further extension to this<br />
guarantee is required, the same shall be extended to such period on receiving instructions from the tenderer on<br />
whose behalf this guarantee is issued. This guarantee will remain in <strong>for</strong>ce up to and including 60 days after the<br />
period <strong>of</strong> tender validity and any demand in respect there<strong>of</strong> should reach the Bank not later than the above date.<br />
Date _________________ Signature _______________<br />
Place _________________ Printed Name ____________<br />
Witness ______________ (Designation) ____________<br />
Banker’s Common Seal.