PERFORMANCE STATEMENT FORM (For a period of last 3 years) Name of the Firm………………………. Order Order Value Date of Date of Remarks Has the Contact person No. and and of actual indicating equipment along with Placed by date quantity of order of completion reasons for late been installed Telephone No., (full ordered deliver of delivery delivery, if any satisfactory? FAX No. and address of as per (Attach a e-mail address certificate contract from the Signature and Seal of the manufacturer/Bidder ……………………………. Place :
PERFORMANCE STATEMENT FORM (For a period of last 3 years) Name of the Firm………………………. Order Placed by (full address of Order No. and date and quantity of ordered Value of order Date of of deliver as per contract Date of actual completion of delivery Remarks indicating reasons for late delivery, if any Has the equipment been installed satisfactory? (Attach a certificate from the Contact person along with Telephone No., FAX No. and e-mail address Signature and Seal of the manufacturer/Bidder ……………………………. Place :
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