FORM 4: PROPONENT’S DECLARATION FORM
A. LITIGATION
1. Have you ever been convicted of any criminal offence in any jurisdiction?
Yes No
2. Have any of the director(s) ever had a professional license suspended or revoked?
Yes No
3. Has your organisation ever been the subject of any petition for bankruptcy?
Yes No
4. Does your organisation have any judgments against you?
Yes No
5. Does your organisation have any pending civil litigation matters?
Yes No
6. Does your organisation have any pending criminal matters?
Yes No
7. Has your organisation, or any organisation over which you have had control ever been the
subject of any inquiry or investigation?
Yes No
If you checked Yes to any of the above questions, kindly provide the key facts and decisions,
including dates, relating to these matters on a separate page to be annexed to this document.
B. STATUTORY COMPLIANCE
1. Is your organisation in compliance with the OSH Act 2004 (as amended) in the form of OSH
requirement applicable to your organisation? Kindly provide details of the compliance with
the most recent supporting documents.
Yes No Not applicable
If no or not applicable is selected, please provide details:
_____________________________________________________________________
2. Is your organisation in compliance with the Minimum Wages Act, Chap 88:04 (as
amended)?
Yes No Not applicable
If no or not applicable is selected, please provide details:
_________________________________________________________________________
Eirene Company Limited
I/We………………………………………………………………………………………………..………..make this declaration
conscientiously believing the same to be true, and I/We am/are aware that if there is any
statement in this declaration which is false in fact, which I/We know or believe to be false or do
not believe to be true, I/We may be disqualified from the Tendering process or if awarded the
Tender, the contract will be immediately terminated.
DAYNE FRANCOIS
……………………………………………………………………………………………….
Declarant Name
……………………………………….…..………..… 19.July.2024
…………………………………..
Declarant Signature Date
Managing Director
Position: ………………………. Company Seal:
