Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment NOTE: The applicants will submit fee as demand draft or pay order worth PKR: 75,000 only as one time payable cost. The Agribusiness Support Fund will make all other relevant arrangements for participants under its International Market Access Programme Activity. If you have any reservation in submitting any information please let us have it in writing with proper justification. Submission of incomplete information in response to this query or late submission of information may result in automatic disqualification. ASF will undertake a competitive bidding exercise shortly and accordingly intends to issue a solicitation document to those companies which shall express their interest and provide initial relevant information demonstrating their ability to fulfill ASFs requirements. Detailed specifications will be provided to companies that will be short listed for receipt of the solicitation documents. This Pre-qualification document does not constitute a solicitation. ASF reserves the right to change or cancel these requirements at any time in the pre-qualification and/or solicitation process. ASF considers a firm's qualifications and experience in the service area, and previous performance, when preparing a list of invitees. Thus, submitting a pre-qualification does not automatically guarantee a firm will be considered for receipt of the solicitation when issued. Due to the high volume of communications, ASF is not in a position to issue confirmation of receipt of Prequalification document. INSTRUCTIONS: 12345Use capital letters Mark the applicable boxes Use extra sheets where necessary Attach photocopies of all relevant credentials Attach Demand Draft or Pay Order worth PKR: 75,000 as Fee in favor of Agribusiness Support Fund. 6- Applications for Pre-qualification must be submitted through any track-able courier service on or before July 2nd, 2012 in a sealed envelope marked with the inscription Participation in the WFM Programme at the address given below: The Procurement Department: Agribusiness Support Fund 144-Central Commercial Area Sector DD, Phase IV, DHA, Lahore Ph: 04235899761

Sign/Stamp___________________________________

Page 1 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment SECTION I- GENERAL INFORMATION
Application in Response to:

(Ad published on/Ref #):

Name of Entity

Private Ltd.

Type of Entity

Partnership Other, please specify _________________ 1-

Names of Partners or Directors

23-

Fresh fruits and Vegetables Juices and Nectars Category(s) Applied for Nuts, Dried Fruits, Seeds Fruit Pastes, Sweets etc Canned Fruits and Vegetables Withholding Tax Vendor? (Yes / No) If Yes, Please indicate whether:
Seller of goods (3.5%) Provider of services (6%) Others, please specify

Tax identification numbers:

National Tax Number: _______________________ GST Registration Number: ___________________

Sign/Stamp___________________________________

Page 2 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment
Large Taxpayers Unit

Tax Jurisdiction

Medium Szed Taxpayers Unit Small Taxpayers Unit

Entitys Representative to ASF

Complete Address

Phone Number (Including area code) Fax Number (Including area code) Mobile Number of Representative E-Mail / Web address

Sign/Stamp___________________________________

Page 3 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment SECTION II- BACKGROUND:
Industry / Field of specialization Products with Brand Name(s): (Mention the products for fruits and vegetables you are dealing in for exports). The exports to major export destinations including Russian Federation:

For new comers any export plans for Russian Federation, Central Asian States (mention orders).

Products Being Currently Exported (Make list of products vs destinations. Categories: Fresh fruits, vegetables, preserves, pickles, jams, jellies, canned products, pouch/aseptic packs, dried/dehydrated products, powders, concentrates, juices, drinks, nectars.)

More than 15 years

Number of Years in the business or experienced gained in the business.

10-15 years 5 10 years 1 5 years

Markets Being Served (Countries):

More than 20 Million

Average Annual Export Turnover in last 3 years (In PKR)

15-19 Million 10 - 14 Million 5 - 9 Million

Sign/Stamp___________________________________

Page 4 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment
3- 4 Million Less than 3 Million

Number of export certifications (BRC, IFS, HACCP etc.) acquired:

Availability of Export Facilities (including pack houses, cold stores)

Number of Exhibitions attended so far:

1-

Three Highest Value Export Orders (fruits and vegetables)

23-

2 - 4 Million 4 - 6 Million

_____________ _____________ _____________ _____________ ____________

Current No. of Jobs/orders In Hand (In PKR)

6 - 8 Million 8 - 10 Million 10- 15 Million

More than 15 Million ____________

Sign/Stamp___________________________________

Page 5 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment
1Management Staff ___________ Technical Staff Other Staff ___________ ___________

Number of staff

23-

SECTION III- BANK INFORMATION:

Bank Name

Branch and City Account Title Bank Account Number

SECTION IV- CONFLICT OF INTEREST:

Kindly inform us if you are by any means related to Agribusiness Support Fund or its staff which may influence the outcome of this assessment process. Please mention the nature of relationship with ASF along with names and designations of related AS F personnel in the space provided below:
1. 2. 3.

Sign/Stamp___________________________________

Page 6 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment SECTION V- REFERENCES FROM CLIENTS:
COMPANY NAME OF CONTACT PERSON TELEPHONE / MOBILE NOS. Email

Sign/Stamp___________________________________

Page 7 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment SECTION VI- DECLARATION
I / We hereby confirm that all the information given in this form and in attached document are true and correct to the best of my/our knowledge. I/ We understand that any false information shall result in immediate disqualification. If prequalified by ASF I / we shall strictly adhere to all the rules, regulations, terms and conditions as laid down by ASF. Signature(s) of Proprietor /Partners/Directors

Name Designation CNIC No.

__________________ __________________ __________________

_________________ _________________ _________________ Stamp of Vendor

_________________ _________________ _________________

Specimen Signature of Authorized Representative

Name Designation CNIC No.

__________________ __________________ __________________

IMPORTANT NOTE: Submission of this Application does not guarantee that the applicant shall be registered with ASF ASF may ask for any further details and documents; or may physically inspect the applicants organizational setup / factory at any time without prior notice Please ensure to provide complete information asked for in the absence of which your application will not be considered Sign/Stamp___________________________________
Page 8 of 9

Agribusiness Support Fund USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment SECTION VII- CREDENTIALS Please attach following documents and check the applicable box
Letter of authorization to represent the company with certified specimen signature and copy of CNIC of authorized representative Company Profile on Company Letterhead justifying sufficient capacity to carry through the proposed project through profile of Key Team Members, clientele, experience etc Photocopies of National ID Cards of Proprietor / Partners / Directors In case of partnership, attested copy of partnership deed (Form C if registered) In case of Public/ Private Ltd Company certified copy of Certificate of incorporation In case of Public Ltd Company certified copy of Certificate of Commencement of business In case of Public/ Private Ltd Company certified copy of Memorandum and articles of association. In case of Public/ Private Ltd Company certified copy of latest form 29 National Tax Registration Certificate Sales Tax Registration Certificate Audited financial reports for last three (03) years Copy of Bank Statement (1) year In case of Manufacturers copies of relevant documents to prove that the factory / godown area is owned / leased by you and also that the machinery is owned by you Documentary evidence of relationship with the brand mentioned in Section II- Company Background An undertaking on Non Judicial Stamp paper that you are not defaulters from any bank / any other institute / Company and that you are not blacklisted with any Govt. / Semi Govt. or any Firm / Organization / Company Copies of Orders from major clients to reflect the volume of business you have done with them. Names, designation, telephone numbers of persons of your major clients who could be contacted for reference Any other details please specify: _________________________________________________________________________________ __________________________________________________________________________________

Authorized Representatives Signature

Sign/Stamp___________________________________

Page 9 of 9