Template a solemn declaration stating debt to public authorities



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The Royal library


the national library of denmark and copenhagen

university library




Ref.. 2015-016917




TEMPLATE A


Solemn declaration stating debt to public authorities
  1. In general


Consolidation Act no. 336 of 13 May 1997, on limitation of debtors' participation in public works contracts, etc., stipulates that in connection with the purchase of goods and services, the public contracting entity must demand that any Tenderer makes a solemn declaration stating whether the Tenderer has any outstanding debt payable to any public authorities in the form of taxes, duties and social security contributions under Danish law or the laws of the country in which the Tenderer has its registered office.

The above matters are included in the assessment of whether the company should be excluded from participating in the tender procedure.
In accordance with the aforesaid, the undersigned hereby makes the following solemn declaration

Company’s name:



CVR no. (or similar national registration no.):
  1. Information on any outstanding debt payable to any public authorities





Yes

(tick)


No

(tick)


  1. The company has outstanding debt payable to public authorities.







  1. The company has outstanding debt payable to public authorities, but such debt does not exceed DKK 100,000 (or an equivalent amount in another currency).







  1. The company has outstanding debt payable to public authorities, and such debt exceeds DKK 100,000 (or an equivalent amount in another currency).






Items D, E and F should be completed only if item C above has been ticked as a “yes”







Yes

(tick)


No

(tick)


  1. Security has been provided to the collection authority for payment of the part of the debt exceeding DKK 100,000 (or an equivalent amount in another currency).







  1. Security will be provided to the collection authority for payment of the part of the debt exceeding DKK 100,000 (or an equivalent amount in another currency).








Collection authority
Name:
Address:





Yes

(tick)


No

(tick)


  1. A repayment scheme has been agreed with the collection authority concer­ning any outstanding debt payable, and such scheme has been complied with.








Collection authority
Name:
Address:





Company:
Date:

_____________________________________________



Signature



23. September 2015







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