6. Authorized Representative Information Bidder’s Name: [insert Authorized name] Representative’s Address: [insert Authorized Address] Representative’s Telephone/Fax numbers: [insert Authorized telephone/fax numbers] Representative’s Email Address: [insert Authorized email address] Representative’s 7. Attached are copies of original documents of [check the box(es) of the attached original documents] Articles of Incorporation (or equivalent documents of constitution or association), and/or documents of registration of the legal entity named above, in accordance with ITB 4.3. In case of JV, letter of intent to form JV or JV agreement, in accordance with ITB 4.1. In case of Government-owned enterprise or institution, in accordance with ITB 4.5 documents establishing: Legal and financial autonomy Operation under commercial law Establishing that the Bidder is not dependent agency of the Purchaser 2. Included are the organizational chart, a list of Board of Directors, and the beneficial ownership. JV Members Information Form Bidder’s [The Bidder shall fill in this Form in accordance with the instructions indicated below. The following table shall be filled in for the Bidder and for each member of a Joint Venture]]. Date: [insert date (as day, month and year) of Bid Submission] ICB No.: [insert number of bidding process] Alternative No.: [insert identification No if this is a Bid for an alternative] Page ________ of_ ______ pages 1. Name: [insert legal name] Bidder’s Bidder’s 2. JV [insert legal name] Bidder’s Member’s name: JV’s Member 3. JV country of registration: [insert country of Bidder’s Member’s JV’s Member registration] 4. JV of registration: [insert year of registration] Bidder’s Member’s year JV’s Member
6. Bidder’s Authorized Representative Information Name: [insert Authorized Representative’s name] Address: [insert Authorized Representative’s Address] Telephone/Fax numbers: [insert Authorized Representative’s telephone/fax numbers] Email Address: [insert Authorized Representative’s email address] 7. Attached are copies of original documents of [check the box(es) of the attached original documents] Articles of Incorporation (or equivalent documents of constitution or association), and/or documents of registration of the legal entity named above, in accordance with ITB 4.3. In case of JV, letter of intent to form JV or JV agreement, in accordance with ITB 4.1. In case of Government-owned enterprise or institution, in accordance with ITB 4.5 documents establishing: Legal and financial autonomy Operation under commercial law Establishing that the Bidder is not dependent agency of the Purchaser 2. Included are the organizational chart, a list of Board of Directors, and the beneficial ownership. Bidder’s JV Members Information Form [The Bidder shall fill in this Form in accordance with the instructions indicated below. The following table shall be filled in for the Bidder and for each member of a Joint Venture]]. Date: [insert date (as day, month and year) of Bid Submission] ICB No.: [insert number of bidding process] Alternative No.: [insert identification No if this is a Bid for an alternative] Page ________ of_ ______ pages 1. Bidder’s Name: [insert Bidder’s legal name] 2. Bidder’s JV Member’s name: [insert JV’s Member legal name] 3. Bidder’s JV Member’s country of registration: [insert JV’s Member country of registration] 4. Bidder’s JV Member’s year of registration: [insert JV’s Member year of registration]
Health_Sector_Goods_EN_April2015.docx