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[[[[[[[[[[[[

ISLAMI BANK FOUNDATION (IBF)

Standard Application Form for Enlistment (SAFE) for Goods & Services

Al Rajhi Complex (10 & 11 Floor) 166, Shaheed Syed Nazrul Islam Sarani Bijoynagar, Purana Paltan, Dhaka - 1000

Telephone No. : +88-02-7110151, 7110325, 7119311, 7125567, 7126357, 9155083-4 Mobile No.: 01724-009059 Fax No. : 7110505

E-mail: [email protected]:www.ibfbd.org

2

Guidance Notes on the use of

Standard Application Form for Enlistment (SAFE) for Goods & Services

1. These guidance notes have been prepared by Islami bank foundation for preparing and

maintaining, using the Standard Application Form for Enlistment (SAFE),list(s) of enlisted

suppliers for use only in the case of Procurement of Goods and Services under Limited

Tendering Method (LTM).

2. The procedure for enlistment shall follow the provisions in Rule 52 of the Public

Procurement Rules, 2008 (PPR 2008) in accordance with Section 32 of the Public

Procurement Act, 2006 including amendment there to. SAFE has been adapted based

upon the best national practices to suit the particular needs of Procurement of Goods and

Services.

3. The use of SAFE applies when a procuring entity intends to select suppliers for the

Procurement of goods and services under LTM Method pursuant to Rule 63(2) of the PPR

2008.

4. Procuring Entity’s shall maintain the list of enlisted suppliers by types and categories of

Goods and Services as appropriate.

5. SAFE Document shall be made available to the potential applicant/enlisted suppliers for

enlistment/renewal of enlisted suppliers/contractors as soon as the relevant advertisement

is published in the newspapers/Notice board/ Website.

6. The price of the Application Form shall be fixed by the procuring entity for enlisting the

suppliers / renewing enlistment of the suppliers on the basis of reproduction and

administrative cost of the SAFE documents. The price of Application Form shall be non-

refundable and payable in the form of Pay Order/Bank Draft/postal order in favour of the

procuring entity.

7. Application shall be hand-delivered and upon request from the Applicant the procuring

entity shall provide necessary acknowledgement of receipt. If the SAFE document allows

electronic submission, the same also can be done.

8. Procuring entity shall directly advertise Invitations for Enlistment (IFE) pursuant to Rule90

of the PPR 2008 and IFE shall follow the specified formats in Part A, of Schedule X of the

PPR 2008 (Also provided with this document).

9. IFE shall be advertised usually at the beginning of each Financial Year and preferably be

completed in all respects by July of the Financial Year so as to facilitate participation by the

newly enlisted suppliers in the upcoming Procurement Proceedings, until such time the

previous list will remain in vogue.

3

10. The list shall be prepared/updated on annual basis by an Enlistment Committee and the list

approved by the Head of Procuring Entity (HOPE) or an officer authorized by him or her

pursuant to Rule 52(3) of the PPR 2008. The enlisted suppliers may be retained or

excluded from the approved list upon performance evaluation as per a standard policy

approved by the Head of Procuring Entity which should be made available to prospective

suppliers during the enlistment process. The key performance indicators should also be

made available to them to make them aware about the performance evaluation process.

11. The Procuring entity shall give minimum seven (7) days time for preparation and

submission of Application pursuant to Rule 52 of the PPR 2008.

12. Minimum qualifying requirement for enlistment or renewal of enlistment shall be specified in

Para 4 of the Application Form. For much detailed requirement additional sheets may be

used by the PE/applicants.

13. The selected Applicants shall be required to deposit a predetermined fee of Tk. 5,000

(Taka Five Thousand) as ‘Enlistment Fee’ and Tk 2000.00 (Taka Two Thousand) for

‘Renewal of Enlistment Fee’ in the form of Pay Order/ Bank/Demand Draft in favour of the

Islami Bank Foundation.

4

Standard Application Form for Enlistment (SAFE) for

Goods& Services

1) Radiology &Imaging Equipment

2) CSSD Instruments & Medical Furniture

3) ICU, NICU, PICU, CCU, HDU, Dialysis & Nephrolithotomy Equipment

4) Equipment for Operation Theatre, Loose Tools, Device, Orthopaedics, Neurology, Physiotherapy Equipment

5) Central Medical gas line, Air plant Installation & related Equipment, Cylinder with Oxygen & Accessories

6) Pathological Laboratory Equipment

7) Endoscopy, Gynae & Obs and Urology Equipment

8) Dental Equipment

9) Ophthalmic & ENT Equipment

10) Cardiology Equipment

11) Medical Disposable Items

12) Vehicle with Ambulance & Spare Parts for vehicle

13) Linen for Hospital

14) Construction Related Contractors

15) Consulting Farm for building planning, design, drawing & documentation, Interior Decoration Service

16) Construction Materials: MS Rod, Cement, Ready-mix Concrete, Bricks, Sand, Stone Chips etc., Tiles,

Granite/Marble, Paints with others accessories, Thai-Aluminium, Structure for door, Shutter, Plastic door, Admixture,

Furniture for hospital, SS& MS Grill, Railing works & others Materials for construction

17) Electrical Materials: Electric Cable, Switch, Socket, Circuit Breaker, Fan, Light, Solar-Panel & Related

Accessories

18) Electro-Mechanical Equipment: Sub-Station, Generator, Lift, Air Conditioner (Sole Distributor), Water Pump,

ETP, Washing Plant, Water Heater, Exhaust System & Mortuary

19) Water Supply & Sanitation Deep Tube well, Tube well, PVC, UPVC,CPVC, PPR, Pipe & Fittings, Sanitary

ware, Water Faucet

20) Printing: Calendar, Office File, Various types of Envelop, Pad, other Printing Materials for Office

21) Computer, Server, Printer, UPS, IT Equipment& Related Accessories

Invitation for Enlistment (IFE) No: H&HED/ENLISTMENT /2018/03 Issued on: 20.09.2018 Phone No: 7110325, 7119311, 7125567 Fax No. : 7110505

ISLAMI BANK FOUNDATION

5


Al Rajhi Complex (10 & 11 Floor) 166, Shaheed Syed Nazrul Islam Sarani Bijoynagar, PuranaPaltan, Dhaka - 1000

Invitation for Enlistment (Part A, of Schedule X of the PPR 2008)

1. Procuring Entity Name Islami Bank Foundation

2. Procuring Entity District Dhaka

3. Invitation for Enlistment

4. Invitation Ref No H&HED/ENLISTMENT/2018/03

5. Date 20-09-2018

KEY INFORMATION

7. Procurement Method Limited Tendering Method

PARTICULAR INFORMATION

Date Time

8. Application Closing Date and Time 11-10-2018 3.00PM

9.. Name & Address of the Office(s) Address : Islami Bank Foundation

Al Rajhi Complex (10 & 11 Floors)

166, Shaheed Syed Nazrul Islam Sarani

Bijoynagar, Purana Paltan, Dhaka - 1000

Telephone No. : +88-02-7110151, 7110325, 7119311,

7125567, 7126357, 9155083-4

Mobile No.: 01724-009059Fax No. : 7110505

- Application Form Availability Islami Bank Foundation




- Receiving Application Form Islami Bank Foundation



Bijoynagar, Purana Paltan, Dhaka – 1000

6

INFORMATION FOR APPLICANT

11. Eligibility of Applicant a. Must have valid Trade License

b. Must have TIN&VAT Registration

c. Must have Bank Solvency Certificate

d. Distributorship/Sole Agency Certificate/(If Applicable)

e. NID & Photograph of Proprietor/Owner

f. Any other legal documents as required by Islami

Bank Foundation.

12. Price of Application Form (Tk) 300.00 (Three Hundred) only

13 Enlistment (Tk) 5000.00 (Five Thousand) only

PROCURING ENTITY DETAILS

14. Name of Official Inviting Application Golam Hafiz Ahmed

15. Designation of Official Inviting Application Executive Director

16. Address of Official Inviting Application Address : Islami Bank Foundation




17. Contact details of Official Inviting Application 7110151, 7110325,

7119311, 01724-009059

E-mail:

[email protected]

18. Islami Bank Foundation reserves the right to accept and/orreject any/all applications

(Golam Hafiz Ahmed)

Executive Director Islami Bank Foundation

mailto:[email protected]

7

Application Submission Letter

IFE No:____________ Date:

To

Executive Director Islami Bank Foundation Al Rajhi Complex (10 & 11 Floors) 166, Shaheed Syed Nazrul Islam Sarani Bijoynagar, PuranaPaltan, Dhaka - 1000

I/We declare that, I/we have the legal capacity to enter into a contract with you, and have not been

declared ineligible by the Government of Bangladesh on charges of engaging in corrupt,

fraudulent, collusive or coercive practices.

I/We am/are not submitting more than one Application in this enlistment of enlistment process in

my/our own name or other name or in different names.

I/We have examined and have no reservations to the Document issued by you.

I/We certify that to the best of my/our knowledge, the information provided by me/us is correct and

true.

I/We understand that if any of the particulars and statements provided above is proven to be

incorrect and false, my/our enlistment shall be liable to cancellation.

I/We understand that you reserve the right to reject all the Applications or annul the enlistment

proceeding swith out incurring any liability to Applicant.

Signature of the Applicant

8


Al Rajhi Complex (10 & 11 Floor)


Bijoynagar, PuranaPaltan, Dhaka – 1000

Application [This Form should be completed and signed by Applicant]

To Date :

Executive Director Islami Bank Foundation Al Rajhi Complex (10 & 11 Floors) 166, Shaheed Syed Nazrul Islam Sarani Bijoynagar, PuranaPaltan, Dhaka - 1000

Invitation for Enlistment No: ……………………………………………………….

Application Type: □First Time Application □Renewal Application [USE MARKS]

1. Information of the Applicant

1.1 Applicant’s legal Name:

1.2 Constitution of Applicant:

[USE MARKS]

□ Proprietorship

□ Partnership

□ Pvt. Ltd

□ Public Ltd

1.3 Date of Constitution :

1.4

Business/Mailing Address : Vill/Road ……………………………………….

P.O: ………………………………………….

District/City: ……………………………………...

Post Code: ……………………………………..

Telephone: …………………………………….

Mobile: …………………………………….

Fax: …………………………………….

E-Mail: ……………………………………..

1.5 VAT Registration Number :

1.6 TIN :

9

1.7 Personal Information of

Proprietor/Managing Director/......

Name: …………………………………….

Male / Female [USE MARKS]

Father’s Name: …………………………………………

Mother’s name: …………………………………………

Age: …………………………………………

Educational Qualification: ……………………..

National ID (if any): ………………………………….

1.8 Detailscontinuation of 1.7 Telephone:

Fax:

E-Mail:

1.9 Particulars of Bank Account Name of the Bank:

Branch:

A/C No:

2. Other Information of the Applicant

2.1 Applicant Category

[USE MARKS]

□Standard off- the- shelf

□Custom designed

□Others/Misc. (Specify)

2.2 Number of Employees:

Technical:

Support staff:

Others:

[List of Key Personnel, CV of Technical Personnel are to

be attached with the application]

2.3 Financial Resources available to meet the cash flow: (Attach all relevant papers to support the

financial solvency like Bank Solvency certificate, Bank line of credit availability and other

financial documents to prove financial capacity to undertake the task up to Tk 2,500,000.

No. Source of Financing Amount Available

10

3. Information on Debarment:

3.1 Have you ever been

debarred by any Govt.

agency

[USE MARKS]

□ Yes

□ No

If yes, please state when and

where and for how long.

4. Legal/Regulatory Requirement:

4.1 a. Trade License

b. TIN Certificate

c. VAT Registration

d. Article of Incorporation if applicable.

5. List of supporting documents submitted (tick appropriate one):

5.1 3 copies of PP size photograph of Proprietor/Managing Director □

5.2 TIN Certificate □

5.3 VAT Registration certificate □

5.4 Affidavit/Articles of Incorporation of the Firm (as applicable) □

5.5 Valid Trade License □

5.6 Evidence in support of age of Proprietor/Managing Director i.e.NID □

5.7 Original or copies of certificates for supply, from concerned

departments/organisations/clients,(Refpara 4) □

5.8 An affidavit, confirming that the Applicant has the legal capacity to enter into

a contract with Procuring Entity, and have not been declared ineligible by the

Government of Bangladesh on charges of engaging in Corrupt, Fraudulent,

Collusive or Coercive practices

□

5.9 Documentary evidence of supplying goods and related services □

5.10 Pay Order/Bank Draft/Bank Guarantee against enlistment fee; money receipt

for application document

Specimen Signature of the

Applicant:

11

Affidavit to be submitted by Applicants

(To be executed on Tk. 300 non-judicial stamp)

I.................................... S/o//D/o........................................... presently residing at

........................ hereby state as follows:

I was born on........................... (date) in ------------------------(name of District)

I take oath and solemnly declare/affirm that, I have the legal capacity to enter into a

contract with Islami Bank Foundation, and have not been declared ineligible by any of the

Procuring Entity’s under any Government/semi Government/autonomous bodies of Government of

Bangladesh on charges of engaging in Corrupt, Fraudulent, Collusive or Coercive practices and I

further declare that I am a Citizen of Bangladesh.

The particulars furnished by me above are correct and that I have not concealed or

misrepresented any facts.

……………………………..

Signature of the Applicant

WITNESSES

1…………………………. 2…………………………………….

Sworn to before me

This…………………………. Day of …………………………..20 at ……………

………………………………………………………………………………

Notary Public

Notary Public

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