Contractor Class to Which Registration is Sought. General Information Name Designation: Head Office/Registered Office: Address/ City/ State/Pin Code Telephone E-Mail PAN No. PF Registration No. GST Registration No. ESIC Registration No. Qualification Questionnaire Nature of past jobs done Total turnover of the past 3 years is at least equal to the upper limit of class applied for YES NO The maximum value of similar work done in the past three years. The minimum value of works that you shall be interested in. Does your organization follow any quality plans / programs? YES NO Does your organization have laid down any safety policy? YES NO Does your organization have ISO/ISRS Certification YES NO Past Performance: Details of works executed during last 3 years.(Furnish the Work Order Copy & Completion Certificate) Details of works in progress(Furnish the Work Order Copies for a few jobs) Time schedule(Furnish status with respect to contractual completion period.) Whether the applicant has been blacklisted or de-registered from the approved list or demoted to a lower class by any organization in the past ? YES NO If Yes Then:- Name of organization , Date of Blacklisting, Reason Whether the applicant has gone for Arbitration/Litigation for any of the past works with any organization? YES NO If Yes then :- Name of Organization , Name of the Work , Nature of Arbitration Other Details: Past Turnover (Last 3 Years) Financial Year : Turn Over in Rs. lakhs Documents Submitted(Audited Copy of Balance Sheet) Manpower Employed: Total no. in permanent employment Number of Graduate / Diploma Engineers Nos. in Safety/Inspn./QC Others Documents Submitted For Electrical Contractors, whether the applicant possesses Valid Electrical Licenses For LT / HT Works? Valid Electrical Contractors License Valid Electrical Supervisor License Nos. of Licensed Electricians Equipment / Facility Details: Workshop Owned YES NO Area of workshop Location List of Tools / Machinery / Erection & construction equipment owned: List of Tools / Machinery / Erection & construction equipment hired/leased: Details of Facilities Available for Design/Drafting. Send
