Tender Submision Form

Annex VI

TENDER SUBMISION FORM

Reference: INVITATION TO TENDER – EIOPA/OP/117/2014 MANAGEMENT OF EIOPA SUBSCRIPTIONS To: EIOPA Westhafen Tower Westhafenplatz 1 60327 Frankfurt am Main Germany

1. Offer submitted by:

Name and address of Tenderer (s) (in case of joint tender list all partners and indicate the leader)

2. Details of contact person (for this procedure)

Name (position)

Telephone Fax E-mail

3. TENDERER'S DECLARATION(S) (To be completed and signed by the tenderer) In response to your letter of invitation to tender for the above contract, we, the undersigned, hereby declare that: 3.1. We have examined and accept in full the content of the dossier for invitation to tender referred above. We hereby accept its provisions in their entirety, without reservation or restriction. 3.2. All partners submitting the joint tender confirm the joint and several liabilities towards EIOPA for the performance of the contract (if applicable). 3.3. We are not in any of the situations excluding us from participating in procedure, as confirmed by attached signed Annex V – Declaration of Honour. It applies also to all and each partner of a group submitting joint tender (if applicable). 3.4. This offer is valid for a period of 3 months from the final date for submission of tenders. 3.5. The technical and financial proposal of the offer is signed by the tenderer or his duly authorized representative. 3.6. The offer is submitted in accordance with the triple envelope system as detailed in the cover letter ‘Invitation to tender’. 3.7. We note that the EIOPA is not bound to proceed with this invitation to tender and that it reserves the right to cancel the whole procedure. It will incur no liability towards us should it do so.

Name and first name: […………………………………………………………………]

Signature: [……………………………………………………………………………..]

Place and date: [……..,.………………………………………………………..……….] Stamp of the firm/company: (in case of a joint offer the form has to be signed by all the members of the group/consortium)

This offer includes the following documents and annexes: (list all the documents included in the offer) Envelope A Envelope B Envelope C