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Model Request for Tender - Department of Finance and Deregulation

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Agency Banking: Market Testing Toolkit - <strong>Model</strong> <strong>Request</strong> <strong>for</strong> <strong>Tender</strong><br />

ANNEX A - DECLARATION BY TENDERER<br />

[....TENDERERS TO INSERT NAME...] A.C.N/A.B.N. [....TENDERERS TO INSERT A.C.N/A.B.N...] (if<br />

any) tenders to provide the Services solicited by the <strong>Request</strong> <strong>for</strong> <strong>Tender</strong> No [....DRAFTERS TO<br />

INSERT RFT IDENTIFICATION PRIOR TO RELEASE OF RFT....] at the fees <strong>and</strong> charges tendered<br />

<strong>and</strong>, subject to the Statement <strong>of</strong> Compliance, in accordance with the draft Conditions <strong>of</strong> Contract.<br />

Acceptance<br />

This tender remains open <strong>for</strong> acceptance until [..TENDERERS TO INSERT DATE..], being<br />

[....TENDERERS TO INSERT PERIOD..] months from the tender closing time. (Refer clause 3.1. <strong>of</strong><br />

Conditions <strong>of</strong> <strong>Tender</strong>).<br />

Improper Assistance<br />

This tender has been compiled without the improper assistance <strong>of</strong> employees or <strong>for</strong>mer employees <strong>of</strong><br />

the [.insert Agency name..], <strong>and</strong> without the use <strong>of</strong> illegally obtained in<strong>for</strong>mation.<br />

REGISTERED OFFICE OR OTHER<br />

ADDRESS OF TENDERER:<br />

.....................................................................<br />

.....................................................................<br />

TELEPHONE:<br />

.....................................................................<br />

POSTAL ADDRESS<br />

.........................................................................<br />

.........................................................................<br />

FACSIMILE:<br />

.........................................................................<br />

Signature <strong>of</strong> tenderer or person authorised to make tender on behalf <strong>of</strong> the tenderer. (Note: if made on<br />

behalf <strong>of</strong> tenderer details <strong>of</strong> the <strong>of</strong>ficial position held should be included such as Director, Manager<br />

etc.)<br />

SIGNATURE:<br />

DATE OF SIGNATURE:<br />

...............................................................<br />

NAME (Block Letters):<br />

...............................................................<br />

SIGNATURE OF WITNESS:<br />

................................................................<br />

.......................................................................<br />

POSITION HELD:<br />

......................................................................<br />

ADDRESS OF WITNESS:<br />

.......................................................................<br />

........................................................................<br />

NAME (Block Letters):<br />

.................................................................<br />

Company executive nominated to receive correspondence/enquiries:<br />

NAME:(Block Letters):<br />

.................................................................<br />

PHONE:<br />

..........................................................................<br />

FACSIMILE:<br />

.........................................................................<br />

Financial Framework Division October 2003 18

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