University of Ilorin Teaching Hospital

UNIVERSITY OF ILORIN TEACHING HOSPITAL

P.M.B. 1459

ILORIN

FORM “R”

APPLICATION FOR REGISTRATION AS A CONTRACTOR

Name of Applicant:………………………………………………………………………………

Address:…………………………………………………………………………………………….

…………………………………………TelephoneNo:………………………………….

This Paragraph should be completed as follows:-

Section ‘A’ is in respect of a limited liability Company.

Section ‘B’ is in respect of Enterprises/Venture

Section ‘C’ is in respect of a Private individual.

Section ‘A”

(a)Name of Company:-……………………………………………………………….

(b)Address of Business:-……………………………………………………………..

………………………………………………………………….

(c)Date of incorporation in Nigeria:……………………………………………………

(d)Registration No:……………………………………………………………………

(e)Paid-up Capital:-……………………………………………………………………..

(f)Name of Director(i)……………………………………………………………

(i)………………………………………………………………………

(ii) ……………………………………………………………………..

(iii) …………………………………………………………………….

(g)Name of Bankers:………………………………………………………………………

………………………………………………………………………

Section ‘B’

(a)Name of your organization:-………………………………………………………..

(b)Date of Registration:-……………………………………………………………….

(c)Place of Registration:-………………………………………………………………

(d)Address of Business:-………………………………………………………………

(e)Capital Employed/Available:-……………………………………………………...

(f)Name/Address of Partnership:-……………………………………………………..

………………………………………………………

(g)Name of Bankers:-………………………………………………………………….

Section ‘C’

(a)Name:-………………………………………………………………………………

(b)Address:-……………………………………………………………………………

(c)Capital Available:-………………………………………………………………….

(d)Name of your Barker:-……………………………………………………………...

………………………………………………………………

(e)Names/Address of 3 reference that can attest to your Capability:-

(1)………………………………………………………………………………

(2)………………………………………………………………………………

(3)………………………………………………………………………………

………………………………………………………………………………

Paragraph 3:Give full details of the professional/Technical

Qualifications of your staff.

Name / Date of Joining Your Organization / Position Held / Qualification

Paragraph 4Indicate the Category/Categories of Contract for which registration is being sought (see Categories of Contractors attached).

………………………………………………………………………………………………………

Paragraph 5:(i)Are you a registered Contractor with the Federal Government/State

Government?(Attach evidenced)

(ii)Give full details of at least three jobs/supplies/consistency services upon which you are either at present engaged or have completed. (Attach evidence)

Nature of job Supplies/ /services and date of award / Location / Value of Contract / Percentage Completed / Name and address of organization/Institution/person who award the contract.

Paragraph 7:

(a)Have you any objection to reference being made to your banker as regards your financial capabilities with respect to the category of job you may likely get through us? Yes/No. (delete which is not applicable).

DECLARATION

(b)I we certify that to the best of my knowledge and belief all the particulars given in these forms are true and correct.

(i)Signed:……………………………………………………………………………………...

Designation:-………………………………………………………………………………..

(ii)Signed:-……………………………………………………………………………………..

Designation:-………………………………………………………………………………..

Name of Witness:-………………………………………………………………………….

Address:-……………………………………………………………………………………

Witness Signature:………………………………………………………………………….

Date:-………………………………………………………………………………………..

REQUIREMENTS FOR REGISTRATION

1.For contract registration, attach photocopies of certificates of registration with appropriate professional bodies.

2.For Pharmaceutical Companies:-

(a)Certificate of Registration of premises by the Pharmacists Council of Nedirian.

(b)Licence of Practice by the Pharmacists covering the premises.

(c)Certificate of incorporation (original) to be sighted by HOD Planning, thereafter attach photocopy to form.

3.In case of Expatriate companies, evidence of compliance with the Nigerian Enterprises Promotion Decree should be attached.

4.For personal business, 2 passport sized photograph should be attached.

5.Satisfactory bank report from any reputable bank.

6.In all cases, the original tax clearance certificate must be sighted by HOD, Planning, thereafter, photocopy should be attached to the form.

7.Payment of Registration Fee after the Company has been found registrable.

NOTE:

1.The University of Ilorin Teaching Hospital reserves the right not to register any Contractor.

2.Registration does not imply that a contract must be awarded by this Hospital.

UNIVERSITY OF ILORIN TEACHING HOSPITAL

P.M.B. 1459

ILORIN

CLASSIFICATION OOF CONTRACTORS

CONTRACT CAPACITY/REGISTRATION FEE/RENEWAL

JOB CATEGORY

(CONSULTATION PROFESSIONALS) / 1
A / 2
A / 3
A / 4
A / 5
A / 6
A

Accounts/Auditors

Architects

EngineersREGISTRATION FEE N2,000.00

(Quantity Surveyo yzzxzRENEWAL N500.00

CONTRACTORS / 1
B / 2
B / 3
B / 4
B / 5
B / 6
B
Building Civil/
Structural Works. Mechanical/Plumbing & Works
Electrical/Power
Plant Installation Works. / CAPACITY
N1-50,000.00
Reg. Fee N250.00
Renewal N100.00 / CAPACITY
N50,001-100,000.00
Reg. Fee N500.00
Renewal N400.00 / CAPACITY
N100,001-250,000.00
Reg. Fee N1,000.00
Renewal N500.00 / CAPACITY
N250,001-500,000.00
Reg. Fee N2,000.00
Renewal N500.00 / CAPACITY
N500,000-2,000,000.00
Reg. Fee N5,000.00
Renewal N1,000.00 / CAPACITY
Above N2.0 Million
Reg. Fee N10,000.00
Renewal N1,250.00
CONTRACTORS:
(GENERAL SUPPLIES) / 1
C / 2
C / 3
C / 4
C / 5
C / 6
C
General Supplies / N1-50,000.00
Reg. Fee N250.00
Renewal N100.00 / N50,001-100,000.00
Reg. Fee N500.00
Renewal N400.00 / N100,001-250,000.00
Reg. Fee N1,000.00
Renewal N500.00 / N250,001-500,000.00
Reg. Fee N2,000.00
Renewal N500.00 / N500,000-2,000,000.00
Reg. Fee N5,000.00
Renewal N1,000.00 / Above N2.0 Million
Reg. Fee N10,000.00
Renewal N1,250.00