Page 20 - All SFAC DOC file
P. 20
Submitted by M/s,Pioneer Holon Agroecology Pvt Ltd
Expression of Interest for empanelling as CBBOs under Central Sector Scheme for formation and promotion of 10,000 FPOs
ANNEXURE III
SELF-DECLARATION FOR NOT TO BE BARRED AND BLACKLISTED
[To be forwarded on the letterhead of the Agency]
Ref. No: Date:
To,
The Managing Director,
Small Farmers’ Agribusiness Consortium,
3, Siri Institutional Area,
th
5 Floor, NCUI Auditorium Building,
August Kranti Marg, Hauz Khas,
New Delhi – 110016
Dear Sir/Madam,
I/We hereby certify that my /our firm/ Company/Society/Trust/Organization has not been
debarred/ blacklisted by any Central Government/ State Government/Govt. Departments and/or
agencies such as UN/bilateral/multi-lateral funding/partner agencies and corporate including
CPSEs, at any time for services of any description, during the last three financial years (FY
2017-18, 2018-19, 2019-20).
Yours faithfully,
Date: (Signature of the Authorised signatory)
Place:
(Name and designation of the of the Authorised signatory)
Name and seal of the Agency
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