2.10.1 If so, furnish particulars: ……………………………………………………… ……………………………………………………… ……………………………………………………… 2.11 Do you or any of the directors / trustees / shareholders / members of the company have any interest in any YES/NO related companies whether or not they are bidding for this contract? 2.11.1 If so, furnish particulars: ……………………………………………………… ……………………………………………………… ……………………………………………………… Full details of directors / trustees / members / shareholders. Full Name Identity Number Personal Tax Reference State Employee Number Number / Persal Number 4. DECLARATION I, THE UNDERSIGNED (NAME)……………………………………………………………………… CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT. I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE. .......................………………………… ………………………………….. Signature Date …………………………………. ……………………………………………… Position Name of bidder May 2011
2.10.1 If so, furnish particulars: ……………………………………………………… ……………………………………………………… ……………………………………………………… 2.11 Do you or any of the directors / trustees / shareholders / members of the company have any interest in any related companies whether or not they are bidding for this contract? YES/NO 2.11.1 If so, furnish particulars: ……………………………………………………… ……………………………………………………… ……………………………………………………… Full details of directors / trustees / members / shareholders. Full Name Identity Number Personal Tax Reference Number State Employee Number / Persal Number 4. DECLARATION I, THE UNDERSIGNED (NAME)……………………………………………………………………… CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT. I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE. ………………………………….. .......................………………………… Signature Date …………………………………. ……………………………………………… Position Name of bidder May 2011