SCIENCE CITY

(National Council of Science Museum)

J. B. S Haldane Avenue
Kolkata – 700 046.

Pre-qualification Form for shortlishing of agencies in connection with tender for

rendering visitor services by way of selling of entry tickets and reception services at
Science City, Kolkata.
(All information should be given in the following format with complete details)

1. Name of the Agency :

2. Full postal address :

3. Contact Telephone Number/Fax no./ Email :

address

i) Office :

ii) After Office hours :

iii) E-mail address :

4. Whether Proprietorship or Partnership :

business or company

5. Date of establishment of the Agency :

6. Name & address of proprietor/ all partners/ :

Directors of the company

7. Number of regular employees :

8. Particulars of registration regarding Trade :

License, ESI, Provident Fund etc.
(submit documentary evidence)

i) Trade license no., date & valid upto :

i) E.P.F registration no. & date :

ii) E.S.I registration no. & date :

(Attach Copy)

iii) Service Tax registration No. & date :

(Attach Copy)

iv) PAN Card no. (Attach Copy) :

Contd…. 2
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9. Nature of the service rendered :

i) Area of specialisation :

ii) Detailed experience on the above work :

(Submit documentary evidence)

iii) Annual turnover exclusively in this :

business

10. Name and full address of Banker of the :

Agency

11. Particulars of latest Income Tax clearance/ :

Return copy

12. Annual turnover of the firm :

Certified that the information furnished above are true to the best of my/our knowledge. It is
hereby declared that I/We will abide by the decision of Science City, Kolkata, for
registration and selection of agencies for issue of tender paper for the services by way of
selling of entry tickets to visitors in Science City.

Place :

Date :

(Signature with date & seal)

N. B. : i) Enclosure may be used if the space is found inadequate;

ii) Last date for the issue of pre-qualification form: 20.10.2010.
iii) Last date for the submission of pre-qualification form: 25.10.2010