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Regional Institute of Medical Sciences, Imphal<br />

APPLICATION FORM NO. 1<br />

GENERAL INFORMATION<br />

All individual firms applying for pre- qualification are requested to complete the information<br />

in this form. Information to be provided for all owners or APPLICANTS who are<br />

partnerships or individually-owned firms.<br />

1. Name of firm<br />

2 Head office address<br />

3<br />

4<br />

Telephone<br />

Fax<br />

| Contact<br />

| E-mail No.<br />

5 Place of incorporation/ | Year of incorporation/ registration<br />

Registration |<br />

|<br />

|<br />

Authorized Signatory of bidder<br />

HSCC/RIMS/2010/01- PI Page - 9

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