ANNEXURE-4 

                               PERFORMANCE STATEMENT 
            (FOR LAST 3 YEARS WITH GOVT./SEMI-GOVT./ LIMITED COMPANIES) 

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    Sl.  Purchaser  P.O.No.   Brief  Qty.  Value  Qty.   Inspect- Satisfact- 
    No.             & date   descri- of          suppl-    ing    ory compl- 
                             ption  stores        ied     autho-  ted letter 
                                                          rity    of purcha- 
                                                                  ser if any 
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     1     2          3         4     5       6    7       8         9 
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                                         Authorised Signatory (ies) 
                                                  with seal 
    (form99)