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Annexure-B

APPLICATION FORMAT

SI No. Particulars Details


1. Name of the Firm with Registration no.
Registration No. and date of Registration of the firm
2. Registered Office Address & date of establishment
3. Branch Office Address & date of establishment
4. Contact No. of the Partner
5. Fax Number
6. Email address & Website
7 Bank Details (for EFT) of bidder.
a)Account Name/Beneficiary name
b)Banker’s Name
c)Branch
d)Address, City/Town, District, State
e)Nature of Account(Cash, Credit, Current, Saving)
f)IFSC Code
g) Account No
8. Name, Membership No. and date of Joining of existing partner with the Firm
having the longest association.
Ref : Selection criteria: SI No. 1
9. Name and Membership No. of the full time partners /proprietor having
experience in practice in the firm whether ACA/ ACMA, FCA/FCMA as on
01.01.2024 and continuing thereafter.
Ref : Selection criteria: SI No. 2(i)
10. Name and Membership No. of the full time partners/proprietor and full time
qualified persons having experience in practice in the firm as on 01.01.2024
having DISA/CISA and continuing thereafter.
Ref : Selection criteria: SI No. 2(ii)
11 Name, Membership No. and joining date of full time qualified assistants who
is an ACA/ACMA having experience working with the firm as on 01.01.2024
and continuing thereafter.
Ref : Selection criteria: SI No. 3
12. Name and date of joining of semi-qualified assistants (Inter Cost/ Inter
Chartered - IPCC - both group) & is working full time with the firm as on
01.01.2024 and continuing thereafter.
Ref : Selection criteria: SI No. 4
13. Experience of the firm in conducting
(A) Statutory/Internal Audit in PSU/Govt. Companies/Listed Companies
(B) Statutory/Concurrent audit in PSU Banks,
(C) Physical verification of Stores & Spares/Fixed assets /Perpetual inventory
audit/Road sale audit or coal sale audit etc. in PSU/Govt.
Companies/Listed Companies
Ref : Selection criteria: SI No. 5
14 Audit firms having Registered Office/Branch Office within the state as on
01.01.2024 and continuing thereafter, wherein the Head quarter of the
Northern Coalfields Limited is situated or is having its mining
operation(Madhya Pradesh/Uttar Pradesh)
Ref: Selection Criteria: Sl No.6

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Further, the following documents are required to be submitted online:

1. Self-attested copy of Latest Firm Registration Certificate/Constitution Certificate downloaded from the
website of Institute of Chartered Accountants of India/Institute of Cost Accountants of India, not earlier than
the date of publication of EOI, showing proof of registered office/branch office within the state.
2. Self-attested copy of membership certificate of Partners and full time qualified persons issued by Institute of
Chartered Accountants of India/Institute of Cost Accountants of India.
3. Self-attested copy of Certificate of Practice of Partners and full time qualified persons issued by Institute of
Chartered Accountants of India/Institute of Cost Accountants of India.
4. Self-attested copy of DISA/CISA of Partners and full time qualified persons issued by Institute of Chartered
Accountants of India/Institute of Cost Accountants of India.
5. Self-attested copy of Membership certificate of Full time qualified assistants issued by Institute of Chartered
Accountants of India/Institute of Cost Accountants of India.
6. Self-attested copy of Mark sheets/Certificate of IPCC/Inter Examination of semi-qualified assistants issued by
Institute of Chartered Accountants of India/Institute of Cost Accountants of India.
7. Self-attested copy of Latest Registration Certificate of PCA/Firm/LLP issued by Institute of Chartered
Accountants of India/Institute of Cost Accountants of India.
8. Self-attested copy of PAN Card of PCA/Firm/LLP.
9. Self-attested copy of GST Registration Certificate (if applicable).
10. (a)Self-attested copy of work order/appointment letter issued of Statutory/Internal Audit issued by PSU/Govt.
Companies/Listed Companies.
(b) Self-attested copy of work order/appointment letter issued of Statutory/Concurrent Audit in PSU Banks.
(c) Self-attested copy of work order/appointment letter issued of Physical verification of Stores &
Spares/Fixed assets /perpetual inventory audit/Road sale audit or coal sale audit in PSU/Govt.
Companies/Listed Companies.
11. All documents including EOI should be duly authenticated / signed by the partners with seal of firm as token of
unconditional acceptance of all term of reference/general terms and conditions.

In absence of the above documents the offer will be rejected. The documents uploaded online to the offer
must be serially numbered and duly signed by the bidder with official seal.

Note: - The participants must provide the copy of complete pages of Work Order/ appointment letter
(including last page of the work order/appointment letter reflecting the signature of issuing authority) for Sl.
No 9.

Date: Signature with seal


Place: Name of the Partner
Membership No.
Name of the Firm
Firm Registration No.

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