Section IV. Bidding Forms 50

###### Bid Submission Form

########## [The Bidder shall prepare his Bid Submission Form on a Letterhead paper specifying the Bidder's complete name, address and communication details]. [Note : All italicized text is for use in preparing these forms by bidders and shall be deleted from the final document.]

Date: [Insert date] ICB No.: 507950

To: AccèsBanque Madagascar, Bâtiment C2, Explorer Business Park, Ankorondrano, 101 Antananarivo, Madagascar,

We, the undersigned, declare that:

- (a) We have examined and have no reservations to the Bidding Documents, including Addenda [Insert Addenda No./Nos., if any] issued in accordance with Instructions to Bidders (ITB 8);
- (b) We meet the eligibility requirements and have no conflict of interest in accordance with ITB 4;
- (c) We have not been suspended nor declared ineligible by the Purchaser based on execution of a Bid Securing Declaration in the Purchaser's country in accordance with ITB 4.4;
- (d) We offer to supply in conformity with the Bidding Documents and in accordance with the Delivery Schedule(s) specified in the Schedule of Requirements the following Goods: [Insert a brief description of the Goods and Related Services] ;
- (e) The total price of our Bid, excluding any discounts offered in item (f) below is:
- i) In case of only one lot, total price of the Bid is: [Insert total price and currency in words and figures] [Delete if multiple lots are offered]
- ii) In case of multiple lots, total price of each lot is: [Insert a list/table showing the total price and currency in words and figures for each lot offered] [Delete if only one lot is offered]
- iii) In case of multiple lots, total price of all lots (sum of all lots) is: [Insert the total price and currency in words and figures for all lots offered] [Delete if only one lot is offered]
- (f) The discounts offered and the methodology for their application are:
- i) The discounts offered are: [Specify in detail each discount offered; if no discount is offered state 'None']
- ii) The exact method of calculations to determine the net price after application of discounts is: [Specify in detail the method that shall be used to apply the offered discounts; if no discount is offered state 'None']
- (g) Our bid shall be valid for a period of [Insert the number of calendar days] days from the date fixed for the bid submission deadline in accordance with the Bidding Documents, and it shall remain binding upon us and may be accepted at any time before the expiration of that period;
- (h) If our bid is accepted, we commit to obtain and submit a performance security in accordance with ITB 42 of the Bidding Documents;
- (i) We are not participating, as a Bidder, in more than one bid in this bidding process in accordance with ITB 4.2(e), other than alternative bids submitted in accordance with ITB 13;
- (j) We, along with any of our subcontractors, suppliers, consultants, manufacturers, or service providers for any part of the contract, are not subject to, and not controlled by an entity or individual that is subject to, a temporary suspension or a debarment imposed by a member of the World Bank Group or a debarment imposed by the KfW, the World Bank in accordance with the Agreement of Mutual Enforcement of Debarment Decisions between the World Bank and other development banks, or any other any other similar funding agency;

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