Price Schedule: Goods Manufactured Outside the Purchaser’s Country, to be Imported Date:_________________________ NCB No: _____________________ (Group C bids, goods to be imported) Alternative No: ________________ Currencies in accordance with ITB 15 Page N ______ of ______ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Item Product Product Strength Dosage Unit Quantity Unit prices Total Local Shipment Name of Ctry. No. code form pack unit price per agent’s weight manufac- of size [a] [b] [c] price item commission and turer origin CIP named Inland Other [a+b+c] [6 x 8] as a % of volume place of transp., incidental CIP destina-tion insurance & costs as included in (specify one) other local defined in the quoted price costs SCC incidental to delivery if specified COC (Levonorgestrel + 1 Ethinylestradiol, 150mg+0.03mg) Cycle 8,331,589 POP (Levonorgestrel 2 0.03mg) Cycle 1,627,377 3 IUCD contraceptive devices, CU-T380A) Set 75,000 4 Beads Set 23,130 ECP (Levonorgestrel 5 75mg) dose 191,608 Total Bid Price: Currency: In figures: In words:
Price Schedule: Goods Manufactured Outside the Purchaser’s Country, to be Imported (Group C bids, goods to be 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 14 Item No. Product code Product Strength Dosage form Unit pack Quantity Unit prices unit Total price per Local agent’s Shipment weight Name of manufac- Ctry. of size [a] CIP named place of destina-tion (specify one) [b] Inland transp., insurance & other local costs incidental to delivery if specified [c] Other incidental costs as defined in the SCC price [a+b+c] item [6 x 8] commission as a % of CIP included in quoted price and volume turer origin 1 COC (Levonorgestrel + Ethinylestradiol, 150mg+0.03mg) Cycle 8,331,589 2 POP (Levonorgestrel 0.03mg) Cycle 1,627,377 3 IUCD contraceptive devices, CU-T380A) Set 75,000 4 Beads Set 23,130 5 ECP (Levonorgestrel 75mg) dose 191,608 Total Bid Price: Currency: In figures: In words:
SBD-KEMSA-WB-THSUC-ONT-01-2016-2018.docx