are part of the Application may be in another language, provided they are accompanied by an accurate translation of the relevant passages in the language specified in the PDS, in which case, for purposes of interpretation of the Application, the translation shall govern. 11. Documents Comprising the Application 11.1 The Application shall comprise the following: (a) Application Submission Letter, in accordance with ITA 12.1; (b) Eligibility: documentary evidence establishing the Applicant’s eligibility, in accordance with ITA 13.1; (c) Qualifications: documentary evidence establishing the Applicant’s qualifications, in accordance with ITA 14; and (d) any document required as specified in the PDS. 11.2 The Applicant shall furnish information on commissions and gratuities, if any, paid or to be paid to agents or any other party relating to this Application 12. Application Submission Letter 12.1 The Applicant complete an Application Submission Letter as provided in Section IV, Application Forms. This Form must be completed without any alteration to its format. 13. Documents Establishing the Eligibility of the Applicant 13.1 To establish its eligibility in accordance with ITA 4, the Applicant shall complete the eligibility declarations in the Application Submission Letter and Form ELI-1.1 (eligibility), included in Section IV, Application Forms. 14. Documents Establishing the Qualifications of the Applicant 14.1 To establish its qualifications to perform the contract(s) in accordance with Section III, Qualification Criteria and Requirements, the Applicant provide the information requested in the corresponding Information Sheets included in Section IV, Application Forms. 14.2 Wherever an Application Form requires an Applicant to state a monetary amount, Applicants should indicate the USD equivalent using the rate of exchange determined as follows: for turnover or financial data required for each year - Exchange rate prevailing on the last day of the respective calendar year (in the amounts for that year is to be converted). value of single contract - Exchange rate prevailing on the date of the contract.
Bid/Proposal Declaration by the Purchaser Declaration pursuant to ITA 4.9. 2.3 Pending Litigation Applicant’s financial position and prospective long term profitability sound according to criteria established in 3.1 below and assuming that all pending litigation will be resolved against the Applicant Must meet requirement N/A Must meet requirement N/A Form PER-1 2.4 Litigation History No consistent history of court/arbitral award decisions against the Applicant since 1st January [insert year] Must meet requirement Must meet requirement Must meet requirement N/A Form PER-1 3. Financial Situation and Performance 3.1 Financial Capabilities The audited balance sheets or, if not required by the laws of the Applicant’s country, financial statements acceptable to the Purchaser, for the last [insert number] years shall be submitted and must demonstrate the current soundness of the Applicant’s financial position and indicate its prospective long-term profitability. Must meet requirement N/A Must meet requirement N/A 3.2 Average Annual Turnover Average annual turnover (Average Annual Sales Revenue) from supply of Health Sector Goods of US$ Must meet requirement Must meet requirement N/A N/A Form FIN – 3.2
in accordance with 4.2(b)(iii) below. Registration Requirement in accordance with 4.2(b)(iv) requirement Must meet requirement requirement Must meet requirement Must meet requirement requirement Must meet requirement 4.2 (b) See below for details
Section IV - Application Forms Table of Forms Application Submission Letter 32 Application Submission Letter Date: [insert day, month, and year] RFB No. and title: [insert RFB number and title] To: [insert full name of Purchaser] We, the undersigned, apply to be prequalified for the referenced RFB and declare that: No reservations: We have examined and have no reservations to the Prequalification Document, including Addendum(s) No(s), issued in accordance with Instructions to Applicants (ITA) 8: [insert the number and issuing date of each addendum]. No conflict of interest: We have no conflict of interest in accordance with ITA 4.6; Eligibility: We (and our subcontractors) meet the eligibility requirements as stated ITA 4.1, we have not been suspended by the Purchaser based on execution of a Bid/Proposal Securing Declaration in accordance with ITA 4.9; Suspension and Debarment: 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 any entity or individual that is subject to, a temporary suspension or a debarment imposed by the World Bank Group or a debarment imposed by the World Bank Group in accordance with the Agreement for Mutual Enforcement of Debarment Decisions between the World Bank and other development banks. Further, we are not ineligible under the Purchaser’s country laws or official regulations or pursuant to a decision of the United Nations Security Council;