FORMAT-IX (A)

PERFORMA OF DECLARATION

Ref no. ……………………..

Date: 31-10-2018

To
The Director,
HAREDA, Panchkula (Haryana).

Dear Sir/ Madam,

I, PRAYAG KAUSHIK authorized representative of M/s PINAK POWER ASSOCIATES

(OPC) Pvt. Ltd. do hereby solemnly declare that our firm M/s PINAK POWER
ASSOCIATES (OPC) Pvt. Ltd. has never been blacklisted by any State Government /
Central Government or any Agency and that we shall be liable for consequence of wrong
declaration.

Signature along with Seal of Co.

………………………………………
(Duly authorized to sign the tender on behalf of the Contractor)

Name PRAYAG KAUSHIK

Designation: DIRECTOR
Name of Co. PINAK POWER ASSOCIATES (OPC) Pvt. Ltd.
(in Block Letters)