ANNEX 1 – to Request for Tender no. 3/10/2016/CD20dated 25.10.2016

FORM OF TENDER

(template)

  1. Name and address of tenderer and its registration details, including NIP (tax ID):

…………………………………

…………………………………

…………………………………

  1. Name, phone number and e-mail of the contact person:

…………………………………………

………………………………………..

………………………………………..

  1. Information about status of the methods (considered in evaluation criteria)

Method / Qualified / validated for Rituximab [YES / NO] / LOD, LLOQ, if concerns / Acceptance criteria
  1. Information about quality system using in Tenderer’s facility
  1. Value of the tender as per the wording of the tender evaluation criterion for price:
  1. Net price: ……………………… [in words: ……………………….]
  2. Gross price: ……………………. [in words: ……………………….]
  1. The date of commencement of work, from the moment of signing the agreement:
  1. Execution time of object of the contract ( from analysis performance to final repot deliver) - considered in evaluation criteria
  1. End date of tender validity period:

XX.XX.2016

  1. I agree to:

a. place the following point to the contract:

“In case of any error occurring, that may affect final results; the Performer
is obligated to find optimal solution that will provide satisfactory results (meeting the initial arrangements). Samples repetition should be carry out without additional quotation for within initial timelines”

□ YES □ NO

b. allow a delegated person from Contracting Entity Company to carry out visit
to make sure the Tender’s company is able to deliver results of appropriate quality before cooperation starts

□ YES □ NO

  1. Validity of tenders

I decelerate, that following tender is valid for 90 days from the deadline for submission
of tenders.

Place and date: ………………………..

…..………………………………………………………………….…..

Signature of Tenderer or Tenderer's authorised representative

and company seal (if Tenderer is an entity that runs business activity)

ANNEX 2 – to Request for Tender no. 3/10/2016/CD20dated 25.10.2016

STATEMENT ON THE ABSENCE OF PERSONAL OR CAPITAL LINKS

I, the undersigned ……………………………………………………………………………………………………………....., [name and surname of Tenderer or its authorised representative], declare that …………………………………. [name oftenderer]has / I have no personal or capital links with Contracting Entity.

Capital or personal links are understood as mutual ties between Contracting Entity
or persons authorised to bind Contracting Entity or persons who act on behalf of Contracting Entity in connection with preparing and conducting the procedure for selection of
a contractor, and the contractor, which are in particular the following:

1.participation in a partnership as a partner of a civil law partnership or general partnership,

2.holding a least 10% of shares,

2.serving as a member of a supervisory body or a managing body, acting as a registered representative (prokurent) or an attorney,

3.being a spouse, a relative by lineal consanguinity or affinity, by collateral consanguinity to the 2nd degree or affinity to the 2nd degree, or a person linked by way
of adoption, custody or legal guardianship.

Place and date: ………………………..

…..………………………………………………………………….…..

Signature of Tenderer or Tenderer's authorised representative

and company seal (if Tenderer is an entity that runs business activity)