Agribusiness Support Fund

USAIDs Agribusiness Project

Pre-Qualification Registration & Assessment

Page 1 of 9
NOTE:

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.

INSTRUCTIONS:

1- Use capital letters
2- Mark the applicable boxes
3- Use extra sheets where necessary
4- Attach photocopies of all relevant credentials






Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 2 of 9
SECTION I- GENERAL INFORMATION

Application in Response to:
(Ad published on):


Name of Entity


Type of Entity

Private Ltd.

Proprietorship

Partnership

Other, please specify _________________
Name(s) of Proprietor, Partners or Directors


1-


2-


3-


Category Applied for

Office Furniture

IT equipment (Server, Laptops, Desktops,
Printers, Routers etc.)

Software

General office equipment


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: ___________________






Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 3 of 9

Tax Jurisdiction



Large Taxpayers Unit

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








Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 4 of 9
SECTION II- BACKGROUND:

Industry / Field of specialization

Brand Name(s):
(Mention the Nature of relationship with the
brand- i-e, Owners, Partners, Authorized
representative/ dealer/ Vendor etc.)


Branches/ Regional offices in Pakistan
(Attach additional sheet)



Number of Years in the field being applied for



More than 15 years

10-15 years

5 10 years

1 5 years


Major Clientele List Relevant to this application
With Names and Contact Numbers:
(Attach Additional Sheets)



1-


2-


3-

Plant and Machinery Installed
(specify if needed and use additional sheet)




Average Annual Turnover in last 3 years
(In PKR)


More than 20 Million

15-19 Million

10 - 14 Million

5 - 9 Million

3- 4 Million

Less than 3 Million








Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 5 of 9

Quality assurance certificates
(e.g. ISO, MOODY, BVQI and others)
(Attach details)



Appreciation certificates from client
(Attach details)



Three Highest Value Orders
(In the field applied for)
(Attach details)


1-


2-


3-


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


2 - 4 Million _____________

4 - 6 Million _____________

6 - 8 Million _____________

8 - 10 Million _____________

10- 15 Million ____________

More than 15 Million ____________







Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 6 of 9
Number of staff

1- Management Staff ___________


2- Technical Staff ___________


3- Other Staff ___________


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.











Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 7 of 9
SECTION V- REFERENCES FROM CLIENTS:

COMPANY NAME OF CONTACT PERSON TELEPHONE / MOBILE NOS. Email











Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 8 of 9
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. __________________ _________________ _________________


Specimen Signature of Authorized Representative Stamp of Vendor









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





Agribusiness Support Fund
USAIDs Agribusiness Project
Pre-Qualification Registration & Assessment

Page 9 of 9
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
Payorder of Rs.2,000/ in favor of Agribusiness Support Fund (Non-Refundable) as Processing
Fee


Any other details please specify:

_________________________________________________________________________________

__________________________________________________________________________________



Authorized Representatives Signature