Tender Form - punjab national rural health mission

ANNEXURE – IIIPROFORMA FOR PERFORMANCE STATEMENT(FOR A PERIOD OF LAST 3 YEARS) Name of bidder___________________________________OrderPlaced by(FullAddress ofPurchaser/consignee)OrderNumberandDateDescriptionandquantity oforderedSteamCleaningSystemValueofOrder(Rs.)Date of completionof ContractAs percontractCompltd.dateRemarksindicatingreasonsfor delayif anyHave the goodsbeenfunctioningSatisfactorilyattachdocumentaryproof) **1 2 3 4 5 6 7 8Signature and Seal of the Tenderer: __________________________________** The documentary proof will be certificate from the consignee/end user with cross reference oforder No. and date in the certificate along with a notarized certificate authenticating thecorrectness of the information furnished. If at any time, information furnished is proved to befalse or incorrect, the earnest money furnished will be forfeited and the bidder may beblacklisted / debarred either indefinitely or for period as deemed fit by Mission Director, NRHM21