Section IV - Application Forms Table of Forms Application Submission Letter 32 Application Submission Letter Date: [insert day, month, and year] RFB No. and title: [insert RFB number and title] To: [insert full name of Purchaser] We, the undersigned, apply to be prequalified for the referenced RFB and declare that: No reservations: We have examined and have no reservations to the Prequalification Document, including Addendum(s) No(s), issued in accordance with Instructions to Applicants (ITA) 8: [insert the number and issuing date of each addendum]. No conflict of interest: We have no conflict of interest in accordance with ITA 4.6; Eligibility: We (and our subcontractors) meet the eligibility requirements as stated ITA 4.1, we have not been suspended by the Purchaser based on execution of a Bid/Proposal Securing Declaration in accordance with ITA 4.9; Suspension and Debarment: We, along with any of our subcontractors, suppliers, consultants, manufacturers, or service providers for any part of the contract, are not subject to, and not controlled by any entity or individual that is subject to, a temporary suspension or a debarment imposed by the World Bank Group or a debarment imposed by the World Bank Group in accordance with the Agreement for Mutual Enforcement of Debarment Decisions between the World Bank and other development banks. Further, we are not ineligible under the Purchaser’s country laws or official regulations or pursuant to a decision of the United Nations Security Council;
Section IV - Application Forms Table of Forms Application Submission Letter 32 Application Submission Letter Date: [insert day, month, and year] RFB No. and title: [insert RFB number and title] To: [insert full name of Purchaser] We, the undersigned, apply to be prequalified for the referenced RFB and declare that: No reservations: We have examined and have no reservations to the Prequalification Document, including Addendum(s) No(s), issued in accordance with Instructions to Applicants (ITA) 8: [insert the number and issuing date of each addendum]. No conflict of interest: We have no conflict of interest in accordance with ITA 4.6; Eligibility: We (and our subcontractors) meet the eligibility requirements as stated ITA 4.1, we have not been suspended by the Purchaser based on execution of a Bid/Proposal Securing Declaration in accordance with ITA 4.9; Suspension and Debarment: We, along with any of our subcontractors, suppliers, consultants, manufacturers, or service providers for any part of the contract, are not subject to, and not controlled by any entity or individual that is subject to, a temporary suspension or a debarment imposed by the World Bank Group or a debarment imposed by the World Bank Group in accordance with the Agreement for Mutual Enforcement of Debarment Decisions between the World Bank and other development banks. Further, we are not ineligible under the Purchaser’s country laws or official regulations or pursuant to a decision of the United Nations Security Council;
SPD-Prequalification-Document-HEALTH-SECTOR-Pharmaceuticals-Vaccines-Condoms-July-2016.docx