ANNEXURE – VIII (Refer Rule 18.

1)

PUBLIC WORKS DEPARTMENT

GOVT. OF TRIPURA
APPLICATION FOR REVALIDATION OF ENLISTMENT

[The applicant should study carefully the Rules of Enlistment and the list of documents
to be annexed with the application form before filling the form. Applications found
deficient in any respect are liable to be rejected without any further correspondence]

CLASS

1. (a) Name of the applicant …………………………………

(b) Nature of Entity ........................................................
(Individual/Sole Proprietorship Firm/ Partnership Firm/LLP Firm/Company)

(c) Registration No. For Firm/LLPIN for LLP /CIN for Company .......................

2. Nationality ...................................
3. Address
Regd.
Office…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………

Head Office (if different from registered office)

…………………………………………………………………………………………

………………………………………………………………………………………….

4. Contact Details:
(i) Telephone Number .........................................................
(ii) Fax No. ..............................................................
(iii) Mobile Number .............................................................
(iv) Website URL (if any) .................................................................
(v) Email Id ............................................................

5. Constitution: Individual Sole Proprietorship Firm Partnership Firm

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 Public Ltd. Company Private Ltd. Company LLP Firm
6. Furnish names, paste photograph(s) (Size of photo should be 2.5 X 3.5 cm having white
background and printed name at bottom) and signature of the Individual(s)/All Partner(s)
/Sole Proprietor/All Directors against his/ their names.
1. 2. 3. 4.
Paste photo Paste photo Paste photo Paste photo

Name Name Name Name

7. (a) Name of person holding power of attorney …………………………………………

(b) Nationality: Indian Other

(c) Liabilities (if any): .....................................................................................
8. Name of Bankers with full address …………………………………………………….
And
The sum of annual financial turnover on construction works of the firm in the last three
years duly certified by the Chartered Accountant in proforma Annexure-V-2, should be at
least equal to amount of banker’s certificate (for Class-I composite, class-I, Class-II composite &
Class-II).
9. Place of business ...............................................

10. [For Composite]

(i) Does the applicant possess valid Electrical License Yes No
(ii) Do the permanent electricians employed by contractor
possesses valid license Yes No
11. Details of Enlistment with PWD:
i) Enlistment No. & Date: .................................
ii) Valid up to: .......................................
12. Is any person working with the applicant is a near relative of the officer/official of
PWD [As per Rule 16 of the Enlistment Rules] If yes, give details Yes No

13. Full time technical staff employed in applicant’s Establishment during last 3 years:

(a) Graduate Engineers (no.)

(b) Diploma Engineers (no.)
14. Does the applicant have sufficient T&P, Machinery, Equipment and
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 workshop as per requirements mentioned in the Enlistment Rules
for the class applied for Yes No
[Attach details on separate sheet]
15. Details of PWD and non PWD works completed, in progress and secured during the
last enlistment / revalidation period (to be filled in the Proforma as given in
Annexure-III -1 & III-2). This list should include all works in progress whose gross
amount of works done is more than the required magnitude for the class in which
registration is required. Receipted copy of the Annexure-VII for PWD works also to be
enclosed.
16. Certificates (Strike out whichever is not applicable):

(i) I/We (including all partners) certify that I/We have read the Rules of Enlistment of
Contractors in PWD as amended up to date and shall abide by them.

(ii) I/We certify that I/We will not get myself/ourselves registered as contractor(s) in
the Department under more than one name.
(iii) I/We certify that the information given above is true to the best of our knowledge.
I/We also understand that if any of the information is found incorrect, our enlistment
is liable to be cancelled.
(iv) I/We certify that
a) the constituents of the Firm/LLP /Company reflected in Sl. No. 6 above are as
applicable on the date of this application which tallies with the record of the
registering authority.
b) I/none of the partners/Directors retired as an Engineer of Gazetted rank or as
any Gazetted Officer employed on Engineering or Administrative duties in last
One year.
c) that we have neither under our employment any such person nor shall we
employ any person within One year of his retirement except with the prior
permission of the Government.
(v) I/We certify that T&P Machinery shall be deployed on the execution of work as
required in NIT.
(vi) I/We undertake that, if we do not possess in my/ own name a valid electrical license
as required, we shall associate with an agency having such a license for execution of
work which requires such a license.
(vii) I/We have attached Annexure-IX duly completed and signed.

Signature(s) of applicant(s) as applicable:

Sl. Name Signature Address

1.

2.

Date:

No. Of Documents attached

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 ANNEXURE – IX (Refer Rule-18.0,18.1)
Documents attached for revalidation

Sl. Document Yes No

No
1. Attested copy of power of attorney, if any
2. (i) Banker’s/working capital certificate in original from
scheduled bank in the proforma given in the Enlistment
Rules. The certificate should be on the bank’s letter-head
and in sealed cover and shall be addressed to the
concerned Enlistment Authority. {Annexure-V(1)}
(ii) The average annual turnover on Construction works/
Civil works in the last three years duly certified by the
Charted Accountant, as submitted by the applicant to the
Income Tax Department for class-I composite, class I,
class II composite and class II shall be as per Rule 12.3)
3. Self-Attested copies of valid Electrical License (if any)
4. Self-Attested copy of Enlistment order
5. Annexure III – (1 & 2) List of works completed, in
progress & secured during last enlistment/ revalidation
period.
6. Self-Attested copies of award letters for works included
in Annexure III
7. Copies of Annexure – VII with acknowledgement of
E.E/A. E
8. Late fee (if applicable)
9. Documentary proof (e.g. EPF statement / Pay role etc.) of
Engineers / key personnel engaged as an employee at his
establishment serving for last 3 years wherever applicable

Signature(s) of applicant(s) (As per Annexure-VIII)

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 ANNEXURE – X (Refer Annexure-IX)

Certificate to be submitted by applicant /contractor / firm along with application for

Revalidation

CERTIFICATE

I,…............……………............................. S/o Sri………...........................……………...............

Aged................ Years, R/o
………………………………………………………………………….............................. Sole
proprietor/Partner/Director(as the case may be) of
M/s/Shri………………………………...........................................(Name of firm with
address)……………………………….......................................................................do hereby
solemnly affirm and declare that;

I/we confirm and submit that no work other than shown in the Annexure-III has been
secured and executed by me/us during the period of ............................to
..........................(Indicate period of last valid period of enlistment) . This is my true
statement.

It is verified that my above statements are true and correct to the best of my knowledge
and belief and nothing is concealed therein.

Deponent
Date:
Place:
Applicant Signature (As per Annexure-I)

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