Price Schedule for Goods and Related Services

Date:
ICB No.:
Invitation for Bid No.:
Alternative No.:
Name of the Bidder:
_____________________________________________________________

1 2 3 4 5 6 7 8
Import
Percent of Duties, Sales
Good or Quantity
Country of national Unit Taxes and Total
Item No. Related (No. of
origin origin 1 price 2 other Taxes, Price 3
Service units)
per
unit 2
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ ________ ______ ____ ________ ______
______ ______ ______ _______ ______ ____ ________ ______
_ _ _ _ ___ ______ _

Notes:
1
In accordance with margin of preference ITB Clause 31, if applicable
2
In accordance with ITB Clauses 14 and 15
3
Indicate % of total amount to be paid in foreign currencies and exchange
rates

Name In the capacity of _

Signed

Duly authorized to sign the bid for and on behalf of

______________________________________

___________________________________________________________________
________

Dated on _______________________________ day of _____________________,

______.