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Tender Notice No. AAPC/CHN/OT/001/AV For Security Services/Agencies Sealed Tenders are invited from Security Services / Agencies of repute having valid Firm’s License, Registration E.P.F, E.S.I, and adequate experience (not Less than 5 years) in executing such services to Govt./Semi Govt./Undertaking. Industrial Sector for providing security services as per the Corporation’s requirements on contract basis for a period of two years for ALIMCO Auxiliary Production Centre (AAPC) at Plot No. A1, A2, A3, Industrial Focal Point, Chanalon Kurali (Dist: Mohali ) 140103. Interested Parties are requested to send their written request on their printed letter head for Tender Document to AAPC alongwith payment of Rs 500/- per set of tender document in shape of Demand Draft/Banker’s Cheque in favour of “ALIMCO” payable at Kurali (Mohali) or by cash upto 14:00 Hrs Dated 17.08.2017 or may be downloaded from corporation website www.alimco.in. In case of downloading from website, the bidder have to submit DD of Rs 500/- with T-bid against the tender document cost. A write up on the firm may be provided along with the request letter for tender documents. The Corporation reserves the right to float more than one tender for the above and to reject any or all the application without assigning any reasons thereof. Manager and Unit Head ISO 9001:2008 ALIMCO AUXILIARY PRODUCTION CENTRE ARTIFICIAL LIMBS MANUFACTURING CORPORATION OF INDIA (Govt. of India Undertaking) Plot No. A-1,A-2 & A-3, Industrial Focal Point, Chanalon, Mohali (Punjab) 140103 Phone No. 0160-2642218,19,20&21 [email protected], [email protected]

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Page 1: ALIMCO AUXILIARY PRODUCTION CENTRE ARTIFICIAL …alimco.in/WriteReadData/Tender_Document/AAPC-CHN...1 ALIMCO Auxiliary Production Centre Artificial Limbs Manufacturing Corporation

Tender Notice No. AAPC/CHN/OT/001/AV

For Security Services/Agencies Sealed Tenders are invited from Security Services / Agencies of repute having valid Firm’s License, Registration E.P.F, E.S.I, and adequate experience (not Less than 5 years) in executing such services to Govt./Semi Govt./Undertaking. Industrial Sector for providing security services as per the Corporation’s requirements on contract basis for a period of two years for ALIMCO Auxiliary Production Centre (AAPC) at Plot No. A1, A2, A3, Industrial Focal Point, Chanalon Kurali (Dist: Mohali ) 140103. Interested Parties are requested to send their written request on their printed letter head for Tender Document to AAPC alongwith payment of Rs 500/- per set of tender document in shape of Demand Draft/Banker’s Cheque in favour of “ALIMCO” payable at Kurali (Mohali) or by cash upto 14:00 Hrs Dated 17.08.2017 or may be downloaded from corporation website www.alimco.in. In case of downloading from website, the bidder have to submit DD of Rs 500/- with T-bid against the tender document cost. A write up on the firm may be provided along with the request letter for tender documents. The Corporation reserves the right to float more than one tender for the above and to reject any or all the application without assigning any reasons thereof.

Manager and Unit Head

ISO 9001:2008

ALIMCO AUXILIARY PRODUCTION CENTRE ARTIFICIAL LIMBS MANUFACTURING CORPORATION OF

INDIA (Govt. of India Undertaking) Plot No. A-1,A-2 & A-3, Industrial Focal Point,

Chanalon, Mohali (Punjab) 140103 Phone No. 0160-2642218,19,20&21

[email protected], [email protected]

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ALIMCO Auxiliary Production Centre Artificial Limbs Manufacturing Corporation of India

( A Government Of India Undertaking ) Plot No. A1, A2 and A3, Industrial Focal Point, Chanalon, Kurali , Dist: Mohali 140103

Ph. 0160-2642219,20,21 Web. www.alimco.in E mail: [email protected], [email protected]

TENDER DOCUMENT FOR PROVIDING SECURITY SERVICES M/s__________________________________ _____________________________________ _____________________________________ 1. Sealed Tenders are invited from reputed Security Agencies for providing security

arrangements to the AAPC Chanalon (Dist: Mohali) property & premises, its employees for a period of TWO YEAR.

2. The cost of the tender document is Rs. 500.00 which is non – refundable and may be

submitted along with TC-Bid in the form of DD in favour of “ALIMCO” payable at Kurali (Mohali), in case downloaded from corporation website.

3. Tenders complete in all respects should be submitted in “SEALED ENVELOPE” super scribed as

following :- a) Tender Notice No. : AAPC/CHN/OT/001/AV

b) Opening Date & Time : 17.08.2017 at 15:00 Hrs

c) Addressed to : Manager & Unit Head

ALIMCO Auxiliary Production Centre Plot No. A1, A2 and A3, Industrial Focal Point, Chanalon, Kurali (Dist: Mohali) 140103

4. Submission of Tender Tender shall be submitted in two separate parts sealed individually and marked as Techno Commercial Bid (TC-BID) and Price Bid (P-BID) and both the above said sealed envelopes containing ‘TC-BID and P-BID’ of the tender shall be sealed in another large envelope which should also bear on top Tender Notice No. and date. The Tender and the quoted rates should be valid for 90 days from the date of opening of the tender for acceptance. Rate quoted shall remain valid during the period of contract from the date of appointment.

a) Part-I (TC-BID):- Offer shall be put in an envelope of appropriate size along with EMD Rs 60,000.00 and information as per Appendix I & II and then sealed and boldly marked ‘TC-BID’ along with Tender Notice. No. clearly written on top of the envelope ‘TC- BID’ should be in the format provided at Annexure ‘A’. b) The tenderers are required to submit EMD by Demand Draft/Banker’s Cheque in favour of “ALIMCO”, payable at Kurali (Mohali), as EARNEST MONEY DEPOSIT along with tender. NO OTHER MODE IS ACCEPTABLE. The Earnest money deposit shall be refunded within 45 days of finalization

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2 of the contract to the unsuccessful tenderers. No interest shall be payable on the Earnest Money. This Earnest Money may be adjusted in security deposit amount in case of successful bidder against their written request. Tenders without EMD/inadequate EMD are liable to be rejected irrespective of rates quoted. The Earnest Money will be forfeited if the Tenderer withdraws his Tender before the period of validity (that is minimum 90 days) and/or Tenderer fails to furnish requisite security deposit within the specified period after the award of order/contract, wherever applicable.

c) Part-II (P-BID):- Similarly P-BID offer shall be put in a separate envelope of appropriate size and sealed and boldly marked ‘P-BID’ along Tender Notice No. clearly written on top of the envelope. It shall be in the format of Annexure ‘B’.

d) Please note that there should be no indication with regard to the rates / amounts in any of the documents to be submitted along with sealed envelope marked ‘TC BID’.

e) ALIMCO reserves the right to open the price Bid of those tenderer whose techno Commercial bids are accepted and who have submitted the EMD as per Clause 5 of this tender.

f) Techno - Commercial Bids (TC- BID) not accompanied with the DD/Banker’s cheque towards EMD (ref. Clause 5 ( a) and information as per Appendix I & II will be treated as invalid and will not be considered for any analysis.

5. The tenderers may, at their own discretion, send tenders by Registered/Speed post

Acknowledgement Due. However postal and transit delay will not be condoned in reckoning the tenders for our consideration. Tenders should be addressed to Manager & Unit Head (ref. clause No. 3 (c). Offers received by Fax/Telegraph/Telex/E-Mail will not be considered at all.

6. All the tenders must be deposited in the tender box kept for the purpose in AAPC Chanalon office by 14:30 hrs on or before 17.08.2017. Tender received within the stipulated time will be opened on 17.08.2017 at 15:00 hrs. in the presence of authorized representatives of the tenderers who may like to be present.

7. Only the TC- BID (Part-I) of the tender will be opened on date of opening at 15:00 hrs. by the

Tender Opening Committee in the presence of authorized representatives of the tenderers who may like to be present and the general procedure will be as follows:

a) The tender box shall be closed at 14.30 hrs and opened at 15:00 hrs. The Tender Opening Committee of AAPC Chanalon shall open envelope containing only ‘TC-BID’ part of all tenders. Sealed envelope containing ‘P- BID’ of all tenderers shall be put together in a large cover by the Tender Opening Committee and shall be sealed (in presence of tenderers if present during opening of the tender) which shall be opened on a subsequent notified date and time duly communicating the qualified tenderers by AAPC, Chanalon. b) If any tenderer sends only one envelope i.e only ‘TC-BID’ his tender shall not be considered and shall be treated as incomplete. Similarly if any tenderer sends only one envelope i.e ‘P-BID’, it shall also be treated as invalid tender. c) The Rate & Service Charge for quoting shall be on the basis of Central Minimum Wages as per Minimum Wage Act, 1948, Govt. of India & Ministry of Labour & employments & Ministry of commerce & industry. In case minimum wages quoted in Price Bid are less than the prevailing minimum wages as per Central Government their Price Bid will be rejected.

8. The tenderer should be Registered under Contract Labour (Regulation & Abolition) Act, shop

Commercial Establishment Act, Private Security Act 2005 and should possess valid ESI & PF code numbers for their security personnel & PAN No.. Copies of ESI & PF codes issued by the concerned offices to the agency for its employee & Income Tax clearance certificate should

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be attached with the offer. Offers received without PF/ESI code letter will not be considered. The tenderer must ensure payment of minimum wage to their security personnel and maintain wage register as per law. The successful tenderer shall also have to submit copies of Police Verification report for the character and antecedents of security personnel engaged by the agency.

9. The agency must have more than 100 guards on its payrolls. Documentary evidence in support of this must be provided. The Security Agency shall have a office in Mohali/Chandigarh/Ropar. It should be a professionally run organization and not a garage operation. The office shall have effective communication facilities like Telephone, Fax, Mobile, Email, vehicles.

10. Company having ISO Certificate may be preferred.

11. The tenderer must possess a minimum of 05 years experience of running of security services in

Govt./Private industries of repute.

12. The tenderer should be able to prevent the theft, pilferage, sabotage, fire, mischief or other kinds of loss or damage and to maintain strict vigil in the AAPC Chanalon and its premises as mentioned in para 1 of this tender document.

13. The successful tenderer shall have to deposit @ 10% of the contract value (Two years) in the

form of Demand Draft in the name of “ALIMCO” payable at Kurali (Mohali) as interest free Security Deposit for the performance of its obligation under the agreement before award of the work contract for service. An agreement will have to be executed by the successful tenderer with AAPC Chanalon on a non-judicial stamp paper of Rs. 100/- (Rupees One Hundred Only) after submission of security deposit. The Security Deposit shall be forfeited in the event of any breach of the terms of the contract and non performance.

14. The tenderer will be required to compensate the AAPC Chanalon at the rate of Rs. 1,000/-

(Rupees One Thousand Only) per day or the cost of the alternative arrangements which the AAPC Chanalon may have to make, whichever is higher in case adequate security arrangements are not provided to AAPC Chanalon for any reason whatsoever. The tenderer will have to make good the cost of the damaged/lost goods/property of AAPC Chanalon and accordingly the assessed cost of such goods will be deducted from the bills of the tenderer.

15. The tenderer will have to provide experienced security staff physically fit, trained in fire

fighting and security duties, smart and well conversant in dealing with industrial undertakings, in proper uniform having name badges & shoulder badges with agencies monogram.

16. The period of contract is initially for two years, which may be extended for further two years

on the same terms & conditions on successful completion of two years depending upon satisfactory performance and with mutual agreement.

17. The tenderers should quote their rate on per monthly basis in accordance with Central

Minimum Wages Act of Govt. of India as applicable along with the copy of Govt. notification on the subject and the offer should be without any price escalation clause/condition for a period of 24 Months except increases in minimum wages by Govt., if any which may have to be duly supported by documents. The successful tenderer shall not sublet/sub-contract or assign the contract to any person/body of persons etc.

18. The 75% payment shall be made by AAPC Chanalon within 15 days after receipt of the

clean and clear duly verified monthly bills and balance 25 % shall be released on submission of certified copies of challans of payment of ESI, PF and Service tax alongwith Form No.12 . The copy of detail bank statement (duly signed by security persons )of the salary credited in the accounts of security person deputed at AAPC Chanalon .

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19. FUNCTIONS OF THE SECURITY TO BE DEPLOYED AT ALIMCO, AUXILIARY PRODUCTION CENTRE,

Plot No. A1, A2 and A3, Industrial Focal Point, Chanalon, Kurali (Dist: Mohali) 140103. a) Protection of Machines, Materials and Installations belonging to the AAPC Chanalon

round the clock.

b) Ensure safety of Employees of the AAPC Chanalon and their vehicles within and around the premises of the Auxiliary Production Centre.

c) Control of incoming / outgoing register of employees and visitors maintain records

thereof. d) Control of incoming / outgoing material, proper checking / counting and maintain

records thereof. e) Supervision and verification of loading and unloading of materials. f) Maintenance of movement records of incoming / outgoing vehicles of ALIMCO and

those belonging to visitors and search / checking thereof. g) Prevention of cases of theft, pilferage, sabotage, mischief or other kinds of loss or

damage. h) Maintenance of records of arrival of contracted vehicles. i) Maintenance of records pertaining to late arrival / outgoing / incoming employees of

the AAPC Chanalon. j) Search of outgoing employees by authorized security personnel. k) Implement Fire Orders and maintain Firefighting equipment so as to put off fire

immediately and also prevent fire. l) To escort Cashier from factory to Bank and back. m) To check loading of AAPC Chanalon’s materials dispatched from Warehouse. n) Surveillance/vigil to be alert and alive to provide security, safety to Men and

property. o) To conduct regular drills & training of the security personnel. p) To plan and submit suggestions on security aspects. q) Provision of arrangements for security of vehicles (bicycle/two wheelers/four

wheelers) of AAPC Chanalon employees/guests/visitors/contractors in single/two shift operation on a regular basis as per the instruction of AAPC Chanalon.

20. The performance of the tenderer shall be reviewed/evaluated quarterly by a Joint

Committee nominated by the Manager & Unit Head ALIMCO, Auxiliary Production Centre.

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21. PERSONNEL TO BE ENGAGED (PROPOSED) :

a) Security Supervisor : 01 -

(in General Shift)

b) Security Guard : 06 - ( 02 Nos. Per Shift)

c) Gunman : 01 Should have a minimum qualification of 12th standard with good working knowledge (Spoken & Written) of English, Hindi & Punjabi language and valid License .

d) Health and physique of all the guards should be sound.

22. WORKING TIME FOR SECURITY PERSONNEL.

GUARDS:

a) : From 06:00 hrs. to 14:00 hrs.

b) : From 14:00 hrs. to 22:00 hrs.

c) : From 22:00 hrs. to 06:00 hrs.

SUPERVISOR:

From 09:00 hrs. to 18:00 hrs. With staggered Lunch Break. Gun-Man: From 22:00 hrs to 06:00

It is mandatory that the security supervisor takes surprise rounds during odd hrs. and stays in the premises.

23. The AAPC Chanalon reserves the right to suggest any changes in security arrangements at

any time. The tenderer would employ trained personnel for security purposes and tenderer will be responsible for all the payments/compensation which may be payable to his employees under any law or rules for the time being in force.

24. The tenderer would ensure that the security staff is being provided by him as per contract. The management reserves the right to reject a security staff found below acceptable standard and good behavior/conduct.

25. The management will be free carry out physical check of the total strength of security

personnel deployed by agency on any day and suitable deduction/penalties shall be levied by Manager& Head of the Unit and deductions shall be made from their monthly bills in case of short deployment of the security staff.

26. The agency shall engage the security staff for security duty for single shift of 8 hrs. a day only.

NO DOUBLE DUTY SHALL BE PERMISSIBLE.

Should have a minimum qualification of 12th standard with good working knowledge (Spoken & Written) of English, Hindi & Punjabi language.

Should have a minimum qualification of 10th standard with working knowledge of English, Hindi & Punjabi language.

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6 27. The tenderer should be equipped with sufficient number of guards/supervisors on his rolls to

enable allocation of new team of guards/supervisors once in each quarter or whenever required.

28. The tenderer would arrange for necessary insurance and shall be responsible for all statutory

payment inclusive of all taxes. In no case the AAPC Chanalon would be held responsible for any default of statutory payments related to this contract.

29. The tenderer shall be squarely responsible for all accidental liabilities and compensation

arising or otherwise occurring under any act in respect of his personnel and the AAPC Chanalon shall not be held responsible for the same. In case of any default of timely payment of statutory dues, the AAPC Chanalon shall have the authority to recover such dues from the security deposit held with the AAPC Chanalon and shall not bear any liability on such account.

30. ALIMCO reserves the right to reject any or all the tenders without assigning any reason. The

AAPC Chanalon also reserves the right for negotiations for the rates and terms and conditions with the tenderer out of the techno commercially acceptable offers as per guidelines of CVC prevailing on the day of the tender.

31. The tender document shall also form a part of the agreement, in addition to the terms and conditions of the agreement.

32. The tenderers will abide the decision of the AAPC Chanalon regarding award/rejection of

the contract.

33. In case of any dispute, efforts shall be made to resolve it by mutual discussions failing which the matter will be referred to the Chairman and Managing Director or his nominee for arbitration whose decision shall be final and binding on both the parties. The provision of Indian Arbitration and Conciliation Act 1996 as amended from time to time shall apply to such arbitration proceedings. Arbitration proceedings shall be held at Kanpur Nagar only and the Kanpur Nagar Courts jurisdictions in the matter.

34. Tenderers will be required to furnish information regarding their agencies as per ANNEXURE

‘A’ (Techno-commercial Bid) and ‘B; (Price Bid) and no column will be left blank by the party. Incomplete information in ‘TC-BID’ or ‘P-BID’ are liable to be rejected. All the pages of the tender document to be duly signed by the authorized signatory of the tenderer with seal of the company as a token of acceptance of the terms.

35. A map of Area and reference is enclosed for general guidance at Annexure “C”.

Manager & Unit Head

Encl: As Above.

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APPENDIX – 1 (Page – 01)

PLEASE FURNISH FOLLOWING DETAILS REGARDING YOUR AGENCY/COMPANY. 1. Kindly specify status of your agency (whether proprietorship, partnership, private or

public limited (give details).

2. a) Name, Addresses and Telephone number of the Proprietor/Partner/Directors of

the Agency …………………………………………………………………………………………

…………………………………………………………………………………………………………

b) Brief Bio-Date of each of

Proprietor/Partner/Director……………………………………………………………………..

………………………………………………………………………………………………………..

c) Clients including PSU/Govt. if any for a period of last 3 years (To be attached). d) Year of establishment.

3. License Number Pertaining to : a) Contract Labour (Regulation and Abolition) Act/Factories Act.

b) Shop and Commercial Establishment Act.

c) Registration under Private Security Agency Act 2005.

d) E.S.I.

e) P.F.

f) PAN.

g) GST registration.

Details of authority and attach photocopy.

4. Number of permanent employees engaged by the Security agency with their scales of pay and experience (please specify previous employment, experience etc.).

5. Whether all the employees engaged by you are trained in security functions ? If yes, indicate the name of Institution and period of training.

6. Whether all the employees engaged by you are specially trained for Fire Fighting ? If

yes, indicate the name of Institution and period of training.

7. Is there any liaison of the agency with the local Police, if yes, to what extent ?

8. Give Name and Address of two references (Preferable stationed at Mohali/Chandigarh).

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APPENDIX – I (Page – 02)

9. Specific instances of theft/pilferage prevented/detected by you in various companies (give value) along with details when material were recovered through your effort.

10. Specific instances of fire which may have taken place in any company provided

security by you and details of how it was controlled loss suffered by company etc.

11. Specific instances of industrial unrest faced by company where security was provided by you and what services did you provide at that time.

12. Were there any instances where altercation took place between your guards and

employees of the company or outsiders? Give details with action taken by you.

Date :___________________ Place : __________________

Signature : _________________________________________

Name :____________________________________________ Name of Agency : __________________________________ Address : _________________________________________ _________________________________________ _________________________________________

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(To be submitted with TC – BID)

APPENDIX – II (Page – 01) INFORMATION REQUIRED ABOUT THE BIGGEST COMPANY FOR WHICH SECURITY ARRANGEMENTS HAVE BEEN PROVIDED/ARE BEING PROVIDED. 1. Name & Address of the company for which security is being provided at present.

2. Police Station.

3. District and State in which situation.

4. Capital outlay of the undertaking/company.

5. Critical and vulnerable areas for security in the company covering to the manufacturing and non-manufacturing activities.

6. Total area of the factory manned by you.

7. Total number of workers employed in the factory.

8. Number of unions with strength of each union and political affiliations.

9. Number of woman employees.

10. Number of situations of industrial unrest taken care by you, type of unrest and how it was tackled in this company.

11. Security hazards with special reference to theft, pilferage, sabotage, mischief or other kinds of loss or damage which were handled by you in this company.

12. What is the attitude of the unions towards your security personnel. 13. Type of security arrangements available in the undertaking and provided by your

agency. 14. Number of gates in the factory.

15. Number of inactive gates.

16. What was the system of restricting the entries in and out of bound areas.

17. System of physical security of the stores and warehouses open and covered.

18. System of checking of lunch boxes, tool boxes and other boxes.

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APPENDIX – II (Page – 02)

19. Was the alarm system available in the undertaking and purpose for which it was

used?

20. What were your experiences regarding fire fighting in the company?

21. What were the nature of fire hazardous goods and materials stored by the

company?

22. Type and quantity of fire fighting appliances provided in the company.

23. Details of the staff earmarked for firefighting duties by you.

24. Number of occasion when fire took place and estimated loss of property and how many time it was controlled only by your agency and how many times outside help was sought.

25. What kind of help was sought from the employee of the company in fighting the fire.

26. Have the fire fighting parties been earmarked? What is the extend of help given by the employees for fighting the fire?

27. What was the extent of theft and pilferage in the company during your tenure.

28. Give the number of occasion in which the material lost was recovered with value.

29. Give the details of manpower deputed by you.

30. What were arrangements for checking and supervision of your guards.

Signature :

Name :

Name of the Agency :

Dated :

Address :

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ANNEXURE – ‘A’ (Page 1)

TECHNO-COMMERCIAL BID (TC – BID) DETAILS REGARDING AGENCY/COMPANY TO BE FURNISHED BY TENDERER.

Sl. No. Details of in AAPC Chanalon confirming status of firm.

Proprietor Ship/Partner Ship/Pvt./Public Ltd. (Tick which is applicable)

01 Name, Address and Telephone numbers of the Proprietor/Partner/Director of the Agency and mention the nearest Police Station.

02 Copy of license under (a) contract labour (Regulation and Abolition) Act, Factories Act of (c) Registration under any other authority of the Govt., Private Security Agency Act 2005. (Please specify details of authority and attach certified photocopy)

03 Registration No. of ESI with certified copy of proof and copy of last two years return.

04 Registration No. of EPF with certified copy of proof and copy of last two years return.

05 GST Registration No. and copy of Service Tax Return for last two years .

06 PAN No. (Please attach copy) and copy of last two years Income Tax return.

07 List of clientele served during last three years.

08 Annual Report for last three Financial years.

09 Number and list of employees on the rolls of the security agency for the last three years (Please attach lists)

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ANNEXURE – ‘A’ (Page 2) 10 Name and Address of two references (Preferable

stationed at Mohali / Chandigarh/Ropar))

11 Address of Local Office (Mohali/Chandigarh/Ropar)

12 List of clients including PSU/Govt. if any for a period of last three years.

13 ISO Certification (if any)

14 Information as required vide Appendix – I of tender document.

15 Information as required vide Appendix – II of tender document.

16 Details of EMD

Signature : Name : Dated :

Name of the Agency : Address :

Office Seal/Rubber Stamp

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(To be submitted with PRICE – BID)

ANNEXURE – ‘B’

PRICE BID (P – BID)

SCHEDULE OF RATE FOR DIFFERENT CATEGORY (TENDER TO FILL RATE AND VALUE IN COLUMM 6, 7 & 8

1 2 3 4 5 6 7 8 Sl. No.

Post Category

Qualification Nos. Minimum Wages (per Day)

Minimum Wages (one month say 30 days)

Total value (7X8)

1 Security Supervisor

Skilled (Ex-Serviceman preferable)

Should have a minimum qualifications of 12th standard with good working knowledge (Spoken & Written) of English, Hindi & Punjabi language.

01

2 Gunman Skilled (Ex-Serviceman preferable)

Should have a minimum qualifications of 10th standard with good working knowledge (Spoken & Written) of English, Hindi & Punjabi language with valid License .

01

3 Security Guard

Semi Skilled (Ex-Serviceman preferable)

Should have a minimum education of 10th standard with good working knowledge of English, Hindi & Punjabi language.

6

Total( Column 8 Value) ------------- ---------------- (%) E.S.I. ------------- ----------------

(%) E.P.F. ------------- ---------------- (%) SERVICES CHARGES ------------- ----------------

GST (%){ Column 8 total+ ESI + EPF + Service Charge) ------------- ---------------- Total/Month ------------- ----------------

Total for one year period ------------- ---------------- Total for Two year period ------------- ----------------

Signature: Name: Name of the Agency: Dated : Address:

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14 Office Seal/Rubber Stamp:

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