Vendor Empanelment

Vendor Profiling

Provide a declaration to confirm that the service
provider relationship with any Bajaj Group employees.

Employee Name

Employee code

Function

Department

Designation

Location

Group Company Name

Relationship

If No the below declaration to be given :

This firm / company name is not owned or controlled by any director or officer/ employee of Bajaj Allianz General Insurance Company Ltd and any of Bajaj group Companies. I / We -Directors / partners are not relatives at any employees of BAGIC.

Declaration by the Service provider:

I/we hereby declare that the above information is true to the best of my knowledge and I have furnished the same to Investigation officer .I have gone through the evaluation form understand the timelines. I agree with the same.

Name

Date

Signature (on the printed letter head of the service provider)

Vendor Profiling

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