Annexure - XVI - EIL

1 Annexure - XVI. FORMAT: PDD- HE- 01. SUPPLY LIST FOR HEAT EXCHANGERS AS PER TEMA. Supplier name: Empty weight (kg). Metallurgy &Thickness in mm Welded Grooves/. thickness (mm). Date of supply Tube to Tube Scope of Expanded /. Tube sheet Sheet joint, Welded TEMA Shell service: TEMA Thermal/ Inspection Client Plant Unit Service Class Diameter Type Tube Mechanical/ Authority R/C/B Shell Tube Channel (mm). sheet Fabrication FORMAT: PDD- PV- 01. SUPPLY LIST FOR PRESSURE VESSELS/COLUMNS / REACTORS. Supplier name: Code Metallurgy & Size Rolled Of Date of supply Item Diameter construction Inspection Nozzles Description & Shell Empty Contractual Client Project Service Flanges Qty Value Authority (ASME, BS, Shell D/End Thickness Weight delivery date IS etc.)

2 (mm). FORMAT: PDD- V- 01. SUPPLY LIST FOR VALVES. Supplier name: Valve Service conditions S. Date of supply Temperature Client Project Qty. Inspection Authority User's feedback Remarks No. Pressure Material Rating Type Fluid Size FORMAT: PDD- G- 01. SUPPLY LIST FOR GENERAL ITEMS. Supplier name: Item Description /. Contact Technical Process Fluid Contractual Client / Project Site PO No. Quantity / Inspection Reasons for person & Parameters, Size / / Delivery Date of supply Site Location & Date Value Authority Delay Details Rating, Material Application Date Specifications PDD RM 01. Testing / Overall Assembly / system Service and Manufacturing Engineering Inspection/Location/ system Development Support Despatch point Guarantee EIL Item Code &.

3 Sr No Item (MODEL NO , series ) Major Components If done inhouse Remarks Description If done inhouse If done inhouse If done inhouse If done inhouse mention self , else Specify mention self ,else mention self ,else mention self ,else mention self , else specify sub Self /. specify sub vendor specify sub vendor specify sub vendor specify sub vendor vendor Name & Principals Name & Location Name & Location Name & Location Name & Location Location 1. 2. 1 3. 4. Add Rows if required INCASE OF CERTIFICATION BY STATUTORY AUDITORS THIS FORMAT SHALL BE USED. FORMAT-A. COVERING LETTER ON LETTER HEAD OF STATUTORY AUDITOR/ CHARTERED. ACCOUNTANT. To, Date: Sub: Certificate regarding.

4 Dear Sir, We .. (name of Statutory Auditor/Chartered Accountant) are the Statutory Auditor/Chartered Accountant of M/s .. (name of supplier). We hereby confirm that we have issued following certificate: 1. Supplier Certificate Form - B. 2. Supplier Form C. 3. Form - D. Thanking You, (Signature). Place : Name of Authorised Signatory Date : Membership no.: Encl: As above Note: Supplier whose accounts are not audited by auditors as per Law/Jurisdiction, Certification from a Chartered Accountant (not being an employee or a Director or not having any interest in the Supplier's Company / Firm) to be submitted. INCASE OF CERTIFICATION BY STATUTORY AUDITORS THIS FORMAT SHALL BE USED.

5 FORMAT - B. Certificate from the Statutory Auditor regarding Supply of Goods/ Works/ Services Based on books of accounts and other published information authenticated by it, this is to certify that : 1. PO/FOA/LOA was/were awarded to ..(name of the supplier) and executed as per information mentioned in Supplier Form - C. 2. It is certified that order(s) has/have been executed end user has provided the satisfactory performance feedback(s) as per details mentioned in Form-C. 3. Supporting document for the information mentioned in Supplier Form - C has been verified with original documents. Name of Audit Firm/: [Signature of Authorized Signatory]. Chartered Accountant: Designation: Date: Name: Seal: Membership no.

6 Encl: 1. Supplier Form - C (number of pages -----). 2. Supporting documents for Supplier Form - C (number of pages---). INCASE OF CERTIFICATION BY STATUTORY AUDITORS THIS FORMAT SHALL BE USED. FORMAT C. Sl. Client/ Contact Site PO No. Item Process Quantity Inspection Contractual Insp. Release Date of Date of End user Major No. Project Site Person & Location & Date Description & Fluid & & Authority Delivery note no. and supply commission feedback Reasons Details Technical Application Value Date date -ing ref. no. for Parameters, Delay Size & Rating, *. Material Specifications Name of Audit Firm/ [Signature of Authorized Signatory]. Chartered Accountant : Name: Date: Designation: Seal: Membership no.

7 Note: Copies of following supporting documents to be attached: a) PO/FOA. b) Technical Spec/Drg. c) Inspection release note d) End user feedback e) Any other documents required to be meeting qualification criteria. 1. All pages of supplier Form -C shall be stamped and signed by statutory auditor. *State not applicable INCASE OF CERTIFICATION BY PUBLIC NOTARY THIS FORMAT SHALL BE USED. FORMAT-A. COVERING LETTER ON COMPANY LETTER HEAD. To, Date: Sub: Certificate regarding .. Dear Sir, We .. (Name of Authorised Signatory) are the Authorised Signatory of M/s .. (name of supplier). We hereby confirm that we have certifying the following certificates: 1. Supplier Certificate Form - B.

8 2. Supplier Form C. 3. Form - D. Thanking You, (Signature). Place : Name of Authorised Signatory Date : Encl: As above. INCASE OF CERTIFICATION BY PUBLIC NOTARY THIS FORMAT SHALL BE USED. FORMAT - B. Certificate from the Authorised Signatory regarding Supply of Goods/ Works/ Services This is to certify that : 1. PO/FOA/LOA was/were awarded to ..(name of the supplier) and executed as per information mentioned in Supplier Form - C. 2. It is certified that order(s) has/have been executed end user has provided the satisfactory performance feedback(s) as per details mentioned in Form-C. 3. Supporting document for the information mentioned in Supplier Form - C has been verified with original documents.

9 [Signature of Authorized Signatory]. Place : Designation: Name: Date : Seal: Encl: 1. Supplier Form - C (Number of pages ). 2. Supporting documents for Supplier Form - C (Number of pages ). INCASE OF CERTIFICATION BY PUBLIC NOTARY THIS FORMAT SHALL BE USED. FORMAT -C. Sl. Client/ Contact Site PO No. Item Process Quantity Inspection Contractual Insp. Release Date of Date of End user Major No. Project Site Person & Location & Date Description & Fluid & & Authority Delivery note no. and supply commission feedback Reasons Details Technical Application Value Date date -ing ref. no. for Parameters, Delay Size & Rating, *. Material Specifications [Signature of Authorized Signatory].

10 Place : Designation: Name: Date : Seal: Note: 1. Copies of following supporting documents duly notarized to be attached: a) PO/FOA. b) Technical Spec/Drg. c) Inspection release note d) End user feedback e) Any other documents required to be meeting qualification criteria. 2. All pages of supplier Form -C shall be stamped and signed by authorized signatory. *State , if not applicable THIS IS MANDATORY TO FURNISH IN CASE OF CERTIFICATION BY PUBLIC NOTARY. FORMAT- E. AFFIDAVIT. AFFIDAVIT OF .., S/o D/o ., resident of .. EMPLOYED AS . WITH.. HAVING OFFICE AT ..PIN .. I, the above named deponent do hereby solemnly affirm and state as under:- 1. That I am the authorized representative and signatory of M/s.