Office of the Secretary (e-Gov) - Government of Karnataka

GOVERNMENT OF KARNATAKA
Office of the Secretary (e-Gov), DPAR –AR
Room No 106, I Floor, M.S. Building (Gate-1),
Dr. B.R. Ambedkar Veedhi, Bangalore – 560 001
Telephone: 22353953 Fax: 22259109
e-mail: secyegov-dpar@karnataka.gov.in
Category – XVI- Computer Consumables
(For Bangalore Urban & Rural districts only)
GENERAL CONDITIONS TO BE SATISFIED FOR EMPANELMENT
01 Application fee of Rs.1000/-(non-refundable) per each category in the form of Demand Draft
from any nationalized/scheduled bank, in the name of Secretary, e-Governance, DPAR (AR),
Bangalore, payable at Bangalore, is to be enclosed with the application.
02 The Company should not have blacklisted by State/ Central Govt. departments or Government
Under takings or any organizations. The affidavit stating that the company is not blacklisted
should be submitted along with the application form.
03 The Company’s previous three years audited balance sheet, Annual Report and Income Tax
returns should be enclosed along with the application form
04 The Company’s previous 3 years turnover details and the concerned category turnover for
which the company has applied for empanelment, should be enclosed with the Auditors
certificate
05 The Company’s Incorporation certificate should be enclosed along with application form. (In
case of any change of Company name fresh incorporation certificate should be enclosed along
with the old incorporation certificate.)
06 The Company, which is empanelled, on receipt of the enquiry, and not responding to the
enquiry, will be blacklisted as non-responsive. If the company cannot supply the items as per
the enquiry, a regret letter with reasons is a must.
Note :
1. The empanelment of vendors under various categories does not
mean guarantee for Government enquires/ orders.
2. Government would add or delete any categories at any point of
time as per requirement of end user department.

GOVERNMENT OF KARNATAKA
Office of the Secretary (e-Gov), DPAR –AR
Room No 106, Ist Floor, M.S. Building (Gate-1),
Dr. B.R. Ambedkar Veedhi, Bangalore – 560 001
Telephone: 2235 3953 Fax: 2225 9109
e-mail: secyegov-dpar@karnataka.gov.in
Application for empanelment
Category – XVI- Computer Consumables
(For Bangalore Urban & Rural districts only)
1 Application fee of Rs.1000/-(non-refundable) in the form of Demand Draft from any nationalized
/ scheduled bank, in the name of Secretary, e-Governance, DPAR (AR), Bangalore, payable at
Bangalore, is to be enclosed with the application.
2 The Company should be Manufacturer or an authorized dealer or distributor with annual turnover
in computer consumables of more than Rs.50 lakhs for each of the last 3 years.
(Relevant documents should to be enclosed)
3 The applicant should enclose the details and items of Computer Consumables proposed for
empanelment along with the application form.
4 The Company’s Computer Consumables user base should be at least 200
5 Clients / customers list should be enclosed.
6 Details of the items proposed for empanelment should be enclosed.
7 The Company should provide the details of Computer consumables supplied to the State /
Central Government or Organizations. (List to be enclosed)
Application form for Computer Consumabels
Empanelment for
Printer consumable: Cartridges Toner Ribbon
Printer head Fuser assembly
Media : Floppy USB Sticks
CD
DVD
1. Name & Address of the
Company
2. Local Address of the Company

3. Application fee details
i. Amount of draft
Rs.1000/-
ii. Issue date
iii. Bank name
iv. Branch
3. Original Manufacturer / Dealer / Distributor
(Necessary Certificates to be attached)
4. Details of Contact person
a) Name
b) Designation
c) Phone Number (Office)
d) Fax Number (Office)
e) Cell Number(
f) e-mail address ( Office)
5. Description of Permanent Assets
Asset Description Location Value
Moveable
Immoveable
6. Turnover of the company (Previous 3 Years)
Year Company Turnover Turnover computer consumables
2002-03
2003-04
2004-05
2005-06
7. Consumable Item for which applied for empanelment (Good quality and original
computer consumables only.)
Sl.
No.
Name of the Consumable
Name of OEM company
8. List of Departments/ Organizations for whom Computer Consumables sold (Attach List)
slno Name of the Department Computer Consumables Quantity

10. List major Clients- (Govt, Govt Corporates)
Slno
Department
11. Inventory consumables Details
Consumables details Loaction Value
Date:
Signature & Seal