Name of Bidder Signature of Bidder Date [insert complete name of Bidder] [signature of person signing the Bid] [Insert Date] In the capacity of: or other appropriate designation [ insert: ] Price Schedule: Goods Manufactured Outside the Purchaser’s Country, already imported* C bids, Goods already imported) Date:_________________________ NCB No: _____________________ Currencies in accordance with ITB 15 Alternative No: ________________ Page N ______ of ______ 1 2 3 4 5 6 7 8 9 10 11 12 13 Item Product Product Strength Dosage Unit Quantity Unit prices Total Sales and Name of Ctry. No. code form pack Unit price per other of size price line item taxes origin standard [6x8] payable per item if Contract is awarded [a] [b] [c]=a-b [d] [e] Unit price Custom Unit Inland Other including Duties Price transp., Custom and net of insurance costs Duties Import custom & other as and Taxes duties local costs defined Import paid and incidental in the Taxes and import to SCC paid and taxes delivery payable unit 1 COC (Levonorgestrel + Ethinylestradiol, 150mg+0.03mg) Cycle 8,331,589 2 POP (Levonorgestrel 0.03mg) Cycle 1,627,377
Name of Bidder [insert complete name of Bidder] Signature of Bidder [signature of person signing the Bid] Date [Insert Date] In the capacity of: [ insert: or other appropriate designation ] Price Schedule: Goods Manufactured Outside the Purchaser’s Country, already imported* C bids, Goods already imported) Currencies in accordance with ITB 15 Date:_________________________ NCB No: _____________________ Alternative No: ________________ Page N ______ of ______ 1 2 3 4 5 6 7 8 9 10 11 12 13 Item No. Product code Product Strength Dosage form Unit pack size Quantity Unit prices Unit price Total price per line item [6x8] Sales and other taxes payable per item if Contract is awarded Name of Ctry. of origin standard [a] Unit price including Custom Duties and Import Taxes paid and payable [b] Custom Duties and Import Taxes paid and unit [c]=a-b Unit Price net of custom duties and import taxes [d] Inland transp., insurance & other local costs incidental to delivery [e] Other costs as defined in the SCC 1 COC (Levonorgestrel + Ethinylestradiol, 150mg+0.03mg) Cycle 8,331,589 2 POP (Levonorgestrel 0.03mg) Cycle 1,627,377
SBD-KEMSA-WB-THSUC-ONT-01-2016-2018.docx