Form FIN-2 Summary of Costs Breakdown of Price Per Activity S/N Description of Services Insurance Premium per *Number of people Total Premium per person per person per month cover month 01 In-Patient 4,772 02 Out- Patient 4,772 03 Dental 4,772 04 Maternity 4,772 05 Optical 4,772 Grand Total *Note: THE NUMBER OF PEOPLE COVERED IS AN ESTIMATE SO IT MAY CHANGE Form FIN-3 Breakdown of Remuneration Activity No.______________________________ Name._____________________________________ Names Position Input 1 Remuneration Currency Amount (ie) Rate Regular staff Local staff Consultants Total __________________ 3B-REIMBURSABLES PER ACTIVITY
Form FIN-2 Summary of Costs Breakdown of Price Per Activity S/N Description of Services Insurance Premium per person per month *Number of people cover Total Premium per person per month 01 In-Patient 4,772 02 Out- Patient 4,772 03 Dental 4,772 04 Maternity 4,772 05 Optical 4,772 Grand Total *Note: THE NUMBER OF PEOPLE COVERED IS AN ESTIMATE SO IT MAY CHANGE Form FIN-3 Breakdown of Remuneration Activity No.______________________________ Name._____________________________________ Names Position Input 1 Remuneration Currency (ie) Rate Amount Regular staff Local staff Consultants Total __________________ 3B-REIMBURSABLES PER ACTIVITY
RFP-Medical-Scheme2222.docx