Financial proposal form

FINANCIAL PROPOSAL FORM

From: (Please, Indicate full name):

Date:

Signature:

Reference: Tender #147/2013

Herewith I confirm my intent on provision of services in accordance with Terms of Reference and Procurement Notice

Given the above, please see below my financial proposal and its breakdown

Description of services/travel expenses	Amount (USD)
Fee requested for completion of Stage 1 as per TOR (10 working days)
Fee requested for completion of Stage 2 as per TOR (8 working days)
Fee requested for completion of Stage 3 as per TOR (8 working days)
Fee requested for completion of Stage 4 as per TOR (14 working days)
Total fee for completion of services
Per diems, ticket cost (from Minsk to Kobrin and Mosty) for 1st travel (5 days, during the stage 1, approximately April 2013)
Tickets cost (economy class for air tickets) for 1st travel to Belarus (please indicate itinerary)
Other travel expenses for 1st travel to Belarus (visa, terminals)
Per diems, ticket cost (from Minsk to Kobrin and Mosty) for 2nd travel (3 days, during the stage 2, approximately May-June 2013)
Tickets cost (economy class for air tickets) for 2nd travel to Belarus (please indicate itinerary)
Other travel expenses to for 2nd travel to Belarus (visa, terminals)
Per diems, ticket cost for 3rd travel to Belarus (from Minsk to Kobrin and Mosty) (3 days, during a stage 3, approximately July-September 2013)
Tickets cost (economy class for air tickets) for 3rd travel to Belarus (please indicate itinerary)
Other travel expenses to for 4th travel to Belarus (visa, terminals)
Per diems, ticket cost for 4th travel to Belarus (from Minsk to Kobrin and Mosty) (5 days, during a stage 4, approximately October-November 2013)
Tickets cost (economy class for air tickets) for 4rd travel to Belarus (please indicate itinerary)
Other travel expenses to for 4th travel to Belarus (visa, terminals)
Total travel expenses
Grand Total

*please indicate travel destination and number of days for travel

Prices should be in USD and include all expenses related to the assignment. Contractor is responsible for payment of all relevant taxes.