NOTE: PLEASE SEE PARA 10.2 OF THE POLICY -------------------------------------------------------------------- FORM I-A ---------- (CERTIFICATE OF PAYMENT TO BE ISSUED BY THE PROJECT AUTHORITY FOR SUPPLIES MADE TO CATEGORIES (d), (e), (f) and (g) and (i) OF PARA 10.2 OF THE POLICY) ------------------------------------------------------------------------------------- Certified that the goods of quantity and value as described below and in Invoice No ....................... Dated ......... have been supplied to us on date) against purchase order No. .................... dated ............ and we have paid to the suppliers, namely, M/s. .......................... the sum of Rs.(figures and words) ................................ on ............. (date) being ............................ per cent of the value of the goods / equipments / capital goods supplied as per terms of the contract No. ............... dated ............ entered into with the suppliers in accordance with the conditions applicable to : *(i) Supply of goods to projects financed by multilateral or bilateral Agencies/ Funds as notified by the Department of Economic Affairs, Ministry of Finance vide their Reference No. ....... dated ............, under international competitive bidding or under limited tender system in accordance with the procedures of those agencies / Funds, where the legal agreements provide for tender evaluation without including the customs duty; and *(ii) Supply of capital goods to fertiliser plants if the supply is made under the procedure of international competitive bidding; *(iii) Supply of goods to any project or purpose in respect of which the Ministry of Finance vide their Notification No....... dated ............ , permits the import of such goods at zero customs duty coupled with the extension of benefits under Deemed Exports for domestic supplies. *(iv) Supply of goods to such projects in the power under International Competitive Bidding and refineries under International Competitive Bidding in respect of which the Ministry of Finance extends the benefit of deemed exports to domestic supplies. (v) Supply of goods to UN Organisations under International Competitive bidding in respect of which the Ministry of Finance extends the benefits of deemed export to domestic supplies. It is also certified that the supplies have been accepted by us at the site at the price stated in the invoice. * (use whichever is applicable) Description, Quantity and Value of goods supplied. ..................... ..................... ..................... Signature :............................... Name :............................... Designation :............................... Name of the Project :............................... Place : .............................. Date :............................... Note: 1. This certificate should be signed by the Chief Executive Incharge of the Project concerned or by a senior officer specially authorised by him for this purpose. 2. In case of supplies to Fertilizer Projects, this certificate should be signed by such officer / authorities as may be notified from time to time by the Department of Fertilizers. FORM I-B -------- (CERTIFICATE OF PAYMENT TO BE ISSUED TO THE SUB-CONTRACTOR WHOSE NAME APPEARS IN THE MAIN CONTRACT IN RESPECT OF CATEGORIES (d),(e), (f), (g) and (i) of PARA 10.2 OF THE POLICY) 1. Certified that M/s ...................... is an Indian sub-contractor to M/s ............................... (Main Contractor). The contract of the main contractor has been accepted by us vide No. ....................... date ...........The name of the sub-contractor has been included in the main contract itself and the description, quantity and value of the goods which has now been supplied to us or to the main contractor has already been indicated in the main contract. These supplies conforms to the specifications laid down in the main contract. 2. It is also certified that the goods / equipment of quantity and value as described below and in invoice No. ................ dated ............ have been supplied to us by the above mentioned sub - contractor on .................. (date) against purchase order No. ....................... dated .................. and we have paid to the subcontractor, namely, M/s. .................... the sum of Rs.(figures and words) .................................. on .........(date) being ..................... percent of the value of the goods / equipments / capital goods supplied as per terms of the contract No. ....... dated ........ entered into with the suppliers in accordance with the conditions applicable to: *(i) Supply of goods to projects financed by multilateral or bilateral Agencies / Funds as notified by the Department of Economic Affairs, Ministry of Finance vide their Reference No. ......_ dated ............, under international competitive bidding or under limited tender system in accordance with the procedures of those agencies / Funds, where the legal agreements provide for tender evaluation without including the customs duty; and *(ii) Supply of capital goods to fertiliser plants if the supply is made under the procedure of international competitive bidding; *(iii) Supply of goods to any project or purpose in respect of which the Ministry of Finance vide their Notification No....... dated ............ , permits the import of such goods at zero customs duty coupled with the extension of benefits under Deemed Exports for domestic supplies. *(iv) Supply of goods to such projets in the Power under International competitive bidding and refineries under international competitice bidding of limited global tender in respect of which the Ministry of Finance, extends the benefits of deemed exports to domestic supplies. (v) Supply of goods to UN Organisations under International Competitive bidding or limited global tender in respect of which the Ministry of Finance extends the benefits of deemed export to domestic supplies. * (use whichever is applicable) 3.* It is further certified that the supplies have been made in terms of the contract No. ............... date ............ entered into with the suppliers and the supplies have been accepted by us at site at the price stated in the invoice. We are satisfied that the supplies have been made at international prices. OR ** "It is further certified that the supplies have been made in terms of the contract secured against international competitive bidding in the project being undertaken by us and which has been (a) approved by the Department of Fertilizers vide their Reference No.________ dated ______or (b) notified vide Department of Economic Affairs, Ministry of Finance Reference No______ dated _______ and the supplies have been accepted by us at site at the price stated in the invoice." Signature ........................ Name ........................ Designation ...................... Name of the Project / Agency ................... Place ............... Date ............... Description, Quantity and Value of Goods supplied. ............. ............. ............. Signature ........................... Name ................................ Designation ......................... Name of the Project / Agency ...................... Note :- (1) Note 1 below Form I-A is equally applicable in this case. FORM 1-C ======== Certificate of payment to be issued by the main contractor for supplies made by sub contractor whose name appear in the main contract to categories (d) (e) (f) & (g) and (i) of paragraph 10.2 of the Policy. Certified that the goods of quantity and value as described below and in invoice No.__________ dated __________ have been supplied to us on date ________ against purchase order No.________ dated ________ and we have paid to the sub-contractor namely M/s ___________________ the sum of rupees (figure and words) _______________ on _____________ (date) being ______________ percent of the value of the goods/ components/ equipment/ capital goods supplied as per terms of the contract No. ____________ dated ________ entered into with the sub contractor. It is also certified that we, the main contractor have supplied such goods/ components/ equipments / capital goods supplied by the sub contractor to the project authority against contract no. ________ dated _______ and have received payment on _________ (date) against invoice No. ___________ dated _________ .

S.No	Description Of Goods	Qty	Sub-Contractor
			Invoice No.	Date	Value	Date of Payment

S. No.	Discription of Goods	Qty	Contractor
			Invoice No.	Date	Value	Date of Payment

It is also certified that we have accepted the supplies at the site at the price stated in the invoice. Signature :_________________ Name :_________________ Date: Designation :_________________ Place: Name of the main :_________________ contractor ======================================================== FORM II ------- (UNDERTAKING TO BE GIVEN BY THE APPLICANT) ------------------------------------------ We, M/s........................................ undertake in respect of our application dated ............... against ............................ (description of goods) supplied to ......................... (name of buyer), that :- (1) If at any future date we are required to refund any amount to the buyer,namely ....................... on account of non-satisfactory performance of the equipment during the guarantee period or on account of replacement of defective parts as per contractual agreement we shall send an intimation to the licensing authority giving full particulars within one month of the date of such refund. (2) We shall refund to the licensing authority proportionate amount in respect of the amount refunded to the Project authority by us. Signature ....................................... Name (In Block Letters)............................ Designation ..................................... Place ..................... Date ..................... FORM III -------- ( DECLARATION ) ----------------- We hereby declare and certify that :- (a) particulars stated in the application dated ............................ are correct; (b) the goods as mentioned in application have been supplied to ................................... in terms of the contracts secured by us. (c) the payment against these supplies have been received; and (d) supplies have been made at the prices indicated in Contract No. ....... dated ............. Signature .......................... Name (In Block Letters)................. Designation .......................... Name of the Applicant Firm...................... Place .............. Date ..............