AGREEMENT FOR PROCUREMENT SERVICES

between

GOVERNMENT OF [NATIONAL UNITY or SOUTHERN SUDAN]

and

[UN AGENCY]

FOR THE PROCUREMENT OF [ ]

AS PART OF THE [ ] PROJECT FUNDED BY A GRANT FROM THE
MULTI DONOR TRUST FUND FOR [ ]

[DATE 200X]

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THIS AGREEMENT FOR PROCUREMENT SERVICES (this document together with all
annexes, this “Agreement”) is made this [ ] day of _______ 200__.

BETWEEN The Government of [National Unity or Southern Sudan ]

AND [ UNITED NATIONS AGENCY ] (“XXX”, together with the Government, the
“Parties” and each a “Party”), an international inter-governmental organisation
established by the General Assembly of the United Nations by resolution No. 57(I)
of 11 December 1946 as a subsidiary organ of the United Nations, having its [XXX
Country Office] at [ADDRESS].

WHEREAS:

A. [UN AGENCY] works with governments, civil society organisations and other partners
worldwide to …………..

B. The Government has entered into a Grant Agreement (the “Grant Agreement”) with the
International Development Association (the “Association” as Administrator) pursuant to
which it has been provided with financing for a project on the Protection of Basic Services
(the “Project”).

C. The Project is designed to protect and promote the delivery of basic services by sub-
national governments while deepening transparency and local accountability in service
delivery. The Project focuses on health, education, water and agriculture. Among these,
delivery of health services has been identified as one of the most important components. It
is managed by the Federal Ministry of Health, Department of Planning. In consultation
with the Association, the Government has prepared and approved a procurement plan for
the Project.

D. The Government and [UN AGENCY] have agreed that [UN AGENCY] will provide
procurement services to the Government for the procurement of specific supplies and
equipment, and goods, for use in the Project, as more fully set out in this Agreement.

E. The Government has resolved to use part of the financing referred to in Paragraph [C]
above to meet the financial obligations provided for in this Agreement.

NOW THEREFORE the Parties hereby agree as follows:

ARTICLE I
AGREEMENT DOCUMENTS

1. This document and all its Annexes constitute the agreement between [UN AGENCY] and
the Government for the procurement of the goods listed in Annex II to this Agreement (the
“Goods”), for use in the Project.

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2. The Annexes to this Agreement are the following:

Annex I [UN AGENCY] General Terms and Conditions

Annex II List of Goods and Price Estimates (including handling charges)

Annex III Tentative Delivery Schedule and Consignee List for the Goods

Annex IV Payment Request form

Annex V Template for Utilization Report

Annex VI Schedule of [UN AGENCY]’s handling charges in connection with the

Goods

3. The Agreement documents are to be taken as explanatory of one another, but in case of
ambiguities, discrepancies or inconsistencies among the various documents constituting this
Agreement, the following order of precedence will apply:

(a) This document will prevail over any and all of its Annexes;
(b) Annex I: [UN AGENCY] General Terms and Conditions;
(c) Annexes II to VI

ARTICLE II
SCOPE OF AGREEMENT

1. This Agreement establishes the terms and conditions under which [UN AGENCY] will
procure the Goods requested by the Government for the Project.

2. The Goods will be procured in accordance with [UN AGENCY]'s rules, regulations, and
procedures relating to procurement and its financial regulations and rules and with the same care
and diligence in undertaking procurement using its own funds, having due regard to economy and
efficiency and the need to uphold highest standards of integrity in the administration of public
funds including the prevention of fraud and corruption.

3. During the implementation of the Activities and up to two years after the Activities have
been completed, the [UN Agency] shall retain all documentation with respect to the Activities.
Upon the Government’s or the Association’s reasonable request, the [UN Agency] shall provide
relevant information drawn from such documentation to the Government or the Association.

4. In the event that either the [UN Agency], the Government or the Association becomes
aware of factors that would indicate that corrupt, fraudulent, collusive or coercive practices were
undertaken in relation to the Activities, the [UN Agency] shall take timely and appropriate action to

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remedy the situation, in accordance with the [UN Agency’s] established procedures, Financial
Regulations and Rules, and provide written progress reports to the Government and the Association
regarding the results of the implementation of such appropriate action.

5. For the purposes of this Agreement, the following definitions shall apply:

 “Corrupt practice” means the offering, giving, receiving, or soliciting, directly or indirectly,
of any thing of value to influence the action of a public official in the procurement process
or in the contract execution;
 “Fraudulent practice” means a misrepresentation or omission of facts in order to influence
a procurement process or the execution of a contract;
 “Collusive practices” means a scheme or arrangement between two or more bidders with or
without the knowledge of the Recipient, designed to establish bid prices at artificial, non-
competitive levels;
 “Coercive practices” means harming or threatening to harm, directly or indirectly, persons,
or their property to influence their participation in a procurement process, or affect the
execution of a contract.

6. The procurement of the Goods under this Agreement will be in the estimated quantities and
at the estimated costs provided in Annex II. The specifications of the Goods to be procured under
this Agreement are described in Annex II of this Agreement. The costs of any labelling required
will be included in the price estimate provided by [UN AGENCY]. In an effort to keep costs
within the funds deposited for a particular shipment, either Party shall have the right to decrease
quantities given in Annex II before [UN AGENCY] places Purchase Orders for such Goods. For
increases of quantities given in Annex II the Parties shall consult with each other and establish any
such increases through mutual written agreement.

7. The Goods will be delivered to the consignees and in accordance with the delivery
schedule set out in Annex III. Annex III is a tentative plan at the time of entry into effect of this
Agreement and may be changed at any time by an exchange of letters between the Parties.

ARTICLE III
VARIOUS FINANCIAL MATTERS

Costs

8. The estimated price of the Goods is set out in Annex II. The final price of the Goods will
be based upon the actual purchase price and the actual freight charges (including packing and
insurance charges).

9. If requested by the Government, [UN AGENCY] shall issue a pro forma invoice
containing the information as set out in the Cost Estimate provided by [UN AGENCY] in
accordance with clause 18 below. The Parties agree that the pro forma invoice is only issued to
facilitate the Government’s relations with third parties and shall not establish any obligations

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beyond those contained in the Cost Estimate. To ensure said facilitation, the pro forma invoice shall
include the names of the suppliers and manufacturers of the Goods and their contact information.

10. Before [UN AGENCY] places any Purchase Orders for the Goods, the Government shall
approve all price variations of the Goods from the Cost Estimate. If such approval is not provided
within three (3) working days, the respective purchase shall be excluded from this Agreement. In
this case, neither Party shall have the right to claim damages or assert claims of any other nature
against the other.

Charges

11. The Parties acknowledge that (a) [UN AGENCY]’s standard handling charge for the
procurement of vaccines and warehouse items is __ percent (__%) and (b) [UN AGENCY]’s
standard handling charge for the procurement of non-warehouse items is ____ percent (__%). The
Parties further acknowledge that [UN AGENCY]’s handling charges for the Goods procured under
this Agreement are set out in Annex VI which contains a schedule of the mentioned handling
charges. These charges go to defray costs incurred by [UN AGENCY] in procuring the Goods.

Payment

12. The estimated cost of procurement of Goods under this Agreement is US$ _____ (United
States Dollars ______). All costs, fees, charges and other amounts payable under this Agreement
will be paid to [UN AGENCY] directly by the Association, on behalf of the Government.

13. [UN AGENCY] will maintain a separate ledger account, through which all [UN
AGENCY]'s receipts and expenditures for the purposes of providing the services contemplated by
this Agreement will be recorded (the “_________Procurement Account”).

14. Payment to [UN AGENCY] will be made through the procedures set out in paragraphs 17
and 18.

15. The Government will instruct the Association to make payments to [UN AGENCY] by
transfer to the following bank account:

[Bank address]

For the credit of account:

Credit details:]
Bankcode:
Acount No.:
IBAN No.:
Telex No.

Funds can also be received via Fedwire through: -

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 [Bank details:
SWIFT:
Fedwire:

For the credit of account:

Bankcode:
Account No.:

16. The Government will further instruct the Association that when making such transfers it is
to notify [UN AGENCY], [contact details] by fax _________ or by e-mail (__________), of the
following: (a) the amount transferred, (b) the value date of the transfer; and (c) that the transfer is
from the Association for posting to the ______________Account with Grant Agreement No:
_____________ and reference “_____________”.

The initial Withdrawal Application by the Government and subsequent Payment Requests by
[UN AGENCY]

17. Immediately upon signing of this Agreement by the Government and [UN AGENCY], the
Government will deliver to the Association a blanket withdrawal application (the “Blanket
Withdrawal Application”) covering the total estimated cost of the Goods (including freight
(packing and insurance inclusive) and handling fees) contemplated under this Agreement and
authorizing the Association to make direct payment to [UN AGENCY] of all amounts requested by
[UN AGENCY] in order to perform the services contemplated under this Agreement. The
Government will simultaneously provide a copy of this withdrawal application to [UN AGENCY].
The Government will give notice to [UN AGENCY] immediately upon receiving notice from the
Association that this withdrawal application has been received by the Association in good order
and accepted by the Association.

18. Upon receipt by [UN AGENCY] of the notice from the Government of the acceptance of
the Blanket Withdrawal Application by the Association, and based on the estimated quantities and
costs, the specifications as well as the delivery schedule and consignees specified in Annexes II, III
and IV of this Agreement, [UN AGENCY] will send to the Government price estimates (the “Cost
Estimates”) and specifications corresponding to the first shipment representing the initial six-
month period following the date of signature of this Agreement and to the subsequent shipments
thereafter. A Cost Estimate will be deemed accepted by the Government within ten (10) days of
receipt of the Cost Estimate, unless the Government notifies [UN AGENCY] otherwise in writing,
with a copy to the Association, and communicates the reasons for its rejection to [UN AGENCY] in
writing within the specified period of ten (10) days. In the absence of an objection in writing from
the Government within the said time period, [UN AGENCY] will proceed with submitting payment
requests (the “Payment Request”) together with copies of the Cost Estimate and both Annexes IV
and V to the Association for the respective shipment (based on up-to-date delivery estimates) as set
out in Annex III, with a copy to the Government, requesting the Association to make payment of
the amount to [UN AGENCY]. Upon receipt by [UN AGENCY] of all amounts specified in the
Payment Request, [UN AGENCY] will deliver to the Government, with a copy to the Association,
a notice to that effect.

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Placing Sales Orders and Purchase Orders

19. [UN AGENCY] will place the sales orders and purchase orders covered by a Payment
Request and within the ceiling of the blanket Withdrawal Application only after it receives the full
amount specified in such Payment Request (including freight (packing and insurance inclusive) and
handling fees). [UN AGENCY] will not be required to place any sales order or purchase order if
the full amount specified in the relevant Payment Request is not received within fourteen (14) days
of the date on which that Payment Request is delivered to the Association.

Reporting

20. Within 2 (two) months of the end of each semi- annual period during the term of this
Agreement, [UN AGENCY] will furnish a utilization report (the “Utilization Report”) to the
Government, in respect of that semi- annual period (a “Utilization Report”); provided however that
the final statement of account will be prepared and furnished in accordance with [UN AGENCY]
Procurement Services General Terms and Conditions set out in Annex I. A copy of each such
Utilization Report will also be provided to the Association. Each statement will include:

(a) the amount of funds on deposit in the ___ Procurement Account at the beginning and
end of the reporting period;
(b) the purchase orders entered into by [UN AGENCY] for the Goods during the
reporting period in respect of this Agreement, which shall include the respective
order numbers, their delivery dates, quantity ordered and the supplier selected;
(c) the actual quantities delivered against each purchase order during the reporting
period;
(d) the actual date of delivery of each delivery during the reporting period;
(e) the actual Goods delivered during the reporting period;
(f) the amounts charged to the ____ Procurement Account during the reporting period
and
(g) actual freight amounts charged, and the handling fee charged.

The report will include actual freight amounts charged, and the handling fee charged. Such report
shall be expressed in U.S dollars. The Exchange rate used for converting expenditures in other
currencies shall be the UN Rate of Exchange, as noted below in Annex I Clause 2.

15. The final statement of account will be prepared and furnished in accordance with the [UN
AGENCY] General Terms and Conditions set out in Annex I of this Agreement.

ARTICLE IV
TERMS OF DELIVERY

1. The Government or its nominated representative will be the consignee of the Goods. [UN
AGENCY] will not serve as consignee of the Goods. [UN AGENCY] will arrange for shipment of
the Goods to the port of entry designated by the Government. [UN AGENCY] will forward

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relevant shipping documents, the supplier’s invoice and required product quality assurance
documents (such as but not limited to bill of lading / Air Way Bill, Certificate of Analysis) to the
consignee. [UN AGENCY] will dispatch the aforementioned documents a) within fourteen (14)
days of first vessel departure for sea shipment and b) promptly after receipt of documents from
freight forwarders for air shipment. If [UN AGENCY] is prevented from releasing original
documentation on account of its rules and regulations or contractual obligations, [UN AGENCY]
shall provide certified copies to the consignee. [UN AGENCY] shall inform the Government of
any potential or actual delivery delay as soon as [UN AGENCY] obtains information on such
delay.

2. [UN AGENCY] assures that its contracted freight forwarder(s) will consider [national]
carriers in providing transportation services to Sudan. The Parties note, however, that the selection
of particular carriers is subject to the freight forwarder’s discretion and expertise, and that [UN
AGENCY] does not provide guidance in the selection made by freight forwarders for such
transportation services.

3. All Goods will be delivered on Carriage and Insurance Paid (CIP) (INCOTERMS 2000) to
the port of entry designated in the Cost Estimate, unless otherwise agreed to in writing by the
Parties. Further inland transportation to the warehouse of the _________shall be arranged by [UN
AGENCY] as established in Annex III.

4. Transport insurance information will be issued by [UN AGENCY] on request after receipt
and recording of the freight forwarder’s invoice.

5. On an exceptional basis, if the Government wishes to obtain its own insurance coverage for
the Goods, evidence shall be provided to [UN AGENCY] and the Association that resources are
readily available for prompt payment in a freely convertible currency of the indemnities required to
replace lost or damaged Goods. In such a situation, [UN AGENCY] shall not charge the
Government for insurance coverage.

6. For all shipments, [UN AGENCY] shall monitor the shipping process and inform the
Government of the shipment status.

ARTICLE V
SETTLEMENT OF DISPUTES
NO WAIVER OF PRIVILEGES AND IMMUNITIES

1. The Parties will use their best efforts to settle amicably any dispute, controversy or claim
arising out of or relating to this Agreement. Where the Parties wish to seek such an amicable
settlement through conciliation, the conciliation shall take place in accordance with the
UNCITRAL Conciliation Rules then in force, or according to such other procedure as may be
agreed between the Parties.

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2. Any dispute, controversy, or claim, which is not settled amicably within sixty (60) days
after receipt by one Party of the other Party's request for amicable settlement, will be referred by
either Party to arbitration in accordance with the UNCITRAL Arbitration Rules then in force. The
Parties shall be bound by an arbitration award rendered as a result of such arbitration, as the final
adjudication of such dispute. The Parties will equally share the costs of the procedure. In no event
will [UN AGENCY] be liable for incidental, indirect or consequential damages or for lost revenues
or profits. The arbitral tribunal will have no authority to award punitive damages. The Tribunal
will have no authority to award interest in excess of four percent (4%) and such interest shall be
simple interest not compound. As used herein, the term, "UNCITRAL" means the United Nations
Commission on International Trade Law. The venue of arbitration shall also be agreed amicably
among the parties.

3. Nothing contained in or relating to this Agreement shall be deemed a waiver, express or

implied, of any of the privileges and immunities of the United Nations, including [UN AGENCY],
under the Convention on the Privileges and Immunities of the United Nations, the BCA, or
otherwise.

ARTICLE VI
TERM AND TERMINATION
AMENDMENTS AND MODIFICATIONS

1. The Agreement will be effective on the date it is signed by both parties and will remain
effective until closing date of the Grant Agreement unless the Grant Agreement is extended or
terminated by written agreement between the Association and the Government.

2. This agreement may be terminated for cause either Party upon ninety (90) days written
notice to the other.

3. Upon termination of this Agreement, the Parties will take all reasonable and necessary
measures to conclude the activities already commenced in accordance with this Agreement.

4. The provisions of this Agreement will survive any termination to the extent necessary to
permit an orderly settlement of accounts between the Parties.

5. This Agreement may be altered, modified or amended only by written instrument duly
executed by authorised representatives of the Parties.

ARTICLE VII
INSURANCE AND CLAIMS

1. Goods will be procured subject to the standard product liability and other liability terms
provided by suppliers.

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2. All claims relating to or connected with any defect in the quality or quantity of Goods will be
handled directly by and between the Government and the suppliers/manufacturers. [UN
AGENCY] will, without prejudice, assist the Government in connection with such claims, provided
that any costs incurred in that regard will be borne by the Government. [UN AGENCY] will
provide to the Government any assistance in handling such claims that the Government may
reasonably request. The costs associated with a claim will generally be borne by either the
supplier/manufacturer or the Government, depending on scope and justified evidence of the
concerned claim.

3. [UN AGENCY] acts under this Agreement only as a purchasing agent for the Government, and
accepts no liability for any claims arising from the supply or from the use of the Goods. The
Government will be responsible for handling any claims against [UN AGENCY] in accordance
with the provisions of the BCA.

IN WITNESS WHEREOF, the Parties hereto have executed this Agreement.

For Government of ___________

on _________________ at ________________________

By: __________________________
Name:
Title:

Government Authorized Representative

For [UN AGENCY],

on ___________________ at _______________________

By: ___________________________

Name:
Title: [UN AGENCY] Representative in XXX

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 ANNEX I
[UN AGENCY] GENERAL TERMS AND CONDITIONS

The following are the [UN AGENCY] General Terms and Conditions for Procurement Services,
which apply to this agreement. In the case of any ambiguities, discrepancies or inconsistencies
between these General Terms and Conditions and any other specific provision of this document,
that specific provision will prevail but only to the extent required to resolve such ambiguity,
discrepancy or inconsistency.

Intended Purpose

1. The Government undertakes to ensure that all Goods provided under this Agreement are for
purposes consistent with this Agreement and will be used solely in connection with the Project.

Cost of Purchases

2. Purchases supplied by [UN AGENCY] under this Agreement will be billed at the price stated
by [UN AGENCY]. The Government will be liable for payment of (a) price increases resulting
from the difference between prices given in the price estimates and actual prices to be paid by
[UN AGENCY] to the selected supplier(s) or service provider(s), including variations in freight
costs, as well as currency exchange fluctuations or other incidental costs, and (b) any
subsequent increase in [UN AGENCY]’s handling fee. Similarly, the Government will be
credited in the case of cost decreases.

Procurement and Delivery of Goods

3. Goods will be procured in accordance with [UN AGENCY]’s rules, regulations and
procedures for procurement and financial regulations and rules.

4. Delivery of purchases will be on C.I.P. (Carriage-Insurance-Paid-To) (INCOTERMS 2000),

except where otherwise agreed by the Parties.

Warranty

5. [UN AGENCY] will pass on any warranty offered by the Manufacturer or Supplier used by
[UN AGENCY] to the Government. [UN AGENCY] will not accept the return of any
purchases procured on behalf of the Government.

Customs Clearance

6. The Government will be fully responsible for reception, customs clearance and distribution of
all purchases shipped to their final destination unless agreed otherwise in this Agreement. The
Government or its nominated representative will be the consignee of such purchases.

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 Where [UN AGENCY] provides Services related to this provision and these Services require
that the Government obtains or assists with obtaining permits, licenses and other official
approvals or that the Government furnishes powers of attorney or other authorizations to [UN
AGENCY], the Government shall cooperate in a timely and expeditious manner.

Amendments, Cancellation

7. In regard to purchase contracts which have entered into effect, any amendments, cancellation
or reduction of quantities may only be undertaken with the consent of the Government and
[UN AGENCY]. The Government will be responsible for payment in advance of any
resulting costs.

8. In case of cancellation or reduction of quantities before shipment, the Government will pay
any penalties imposed by Suppliers.

Final Account

9. After shipment of all purchases and recording of all expenses incurred, [UN AGENCY] will
prepare a statement of account to be forwarded to the Government, covering the total cost
under this Agreement. The statement of account will include any variation in the cost of the
Goods, including penalties and credits due to decrease in price or quantities. The statement
will be provided within thirty (30) days of recording all expenses incurred.

10. The statement of account will be expressed in U.S. Dollars. The UN operational rate of
exchange will apply to all currency conversions under this Agreement.

11. In the event that the statement of account indicates a balance of funds in favor of the
Government, these funds will, unless otherwise directed by the Government, be returned to the
Government to a bank account indicated in writing by the Government within thirty (30) days of
receipt of the statement of account.

12. In the event that the statement of account indicates a balance remaining in favor of [UN
AGENCY], the Government will be responsible for ensuring payment of such amounts within
thirty (30) days of receipt of the statement of account.

Liability and Claims

13. [UN AGENCY] does not assume liability, express or implied, written or oral, with regard to
delay of delivery, loss or damage, freedom from fault or infringement of goods, product
quality, characteristics, merchantability, suitability or fitness for any particular purpose, unless
caused by [UN AGENCY]’s failure to execute the procurement with reasonable diligence.
[UN AGENCY] will under no circumstances be liable for any indirect or consequential
damages arising from acceptance or execution by [UN AGENCY] of this Agreement. [UN
AGENCY]'s total liability in any event will not exceed the purchase price of the particular
goods with respect to which a claim is made.

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14. [UN AGENCY] accepts no liability for any third party claims arising out of or in connection
with the acceptance or execution by [UN AGENCY] of this Agreement. The Government
indemnifies and will deal with, defend and hold [UN AGENCY] harmless in connection with
any third party claim or other cause of action arising from the acceptance or execution by [UN
AGENCY] of this Agreement.

Force Majeure

15. Either Party prevented by force majeure from fulfilling its obligations shall not be deemed in
breach of such obligations. The said party shall use all reasonable efforts to mitigate
consequences of force majeure. At the same time, the Parties shall consult with each other on
modalities of further execution of the Agreement. Force majeure as used in this Agreement is
defined as war (whether declared or not), invasion, act of foreign enemies, rebellion, terrorism,
revolution, insurrection, military or usurped power, civil war, riot, commotion, disorder,
ionising radiation or contaminations by radio-activity, and natural catastrophes such as but not
limited to earthquakes, floods, cyclonic or volcanic activity or other acts of a similar nature or
force.

Public Relations

16. The Parties shall coordinate public relations measures, if any, in regard to their cooperation.

Transparency

17. The Government confirms that no official of [UN AGENCY] has received or will be offered by
the Government any benefit arising from this Agreement. [UN AGENCY] confirms the same to
the Government. The Parties agree that any breach of this provision is a breach of an essential
term of this Agreement.

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 ANNEX II
LIST OF GOODS AND
PRICE ESTIMATE (INCLUDING HANDLING CHARGES) FOR THE GOODS

S. Estimated
No Goods Qty UNIT PRICE USD Cost USD

Total = (a)
Packing, Freight,
Insurance Charges = (b)
Handling Fee = (c)
Total a+b+c

Estimates of quantities and costs are based on data available at the time of signature of the
Agreement and therefore provisional

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 ANNEX III
TENTATIVE DELIVERY SCHEDULE AND CONSIGNEE LIST FOR THE
GOODS1

Item
No Description / Destinations Qty of units Delivery Port of Entry

Total

Consignee address:
Tel:
Fax:

1
Annex III is a tentative delivery schedule and may be updated periodically.

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 ANNEX IV
PAYMENT REQUEST

Name of Project: Protection of Basic Services Procurement Account

FOR SIX- MONTH PERIOD BEGINNING [a] AND ENDING [b]

Amount to be paid, in US dollars, expressed in

figures
1. Total amount of funds received from Government

2. Total amount expended by [UN AGENCY] for Goods

provided to the Government
2.a. Purchase of Goods
2.b. [UN AGENCY] standard handling fee, plus
any other agreed-upon charges.
3. Balance available in the account

4. Estimated amount to be expended on behalf of the

Government by [UN AGENCY] during the forthcoming six
month period beginning [b] and ending [b+ 6 months].
4.a. Purchase of Goods
4.b. [UN AGENCY] standard handling fee, plus
any other agreed-upon charges.
5. Present requirement of funds from Government [4-3]

PLEASE PAY

Signature: _________________________
Name: _________________________
Title: ______________________
Date: ______________________

Banking Details:

For the credit of account:

Funds can also be received via Fedwire through: -

For the credit of account:

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 ANNEX V
TEMPLATE FOR UTILIZATION REPORT

Name of Project:
Reference No.

For the Period from _______________ to _________________

Financial Report

US Dollars
1. Cumulative total expenditures made up to the beginning of this reporting
period
1.a. Purchases
1.b. [UN AGENCY] standard handling fee, plus any other agreed-upon
charges.
2. Actual expenditures made during this reporting period
2.a. Purchases
2.b. [UN AGENCY] standard handling fee, plus any other agreed-upon
charges.
Total actual expenditures to the end of the period
(to line 2 of the Withdrawal Application)

Purchases of Goods
[UN AGENCY] standard handling fee, plus any other agreed-upon
charges.
Expenditures forecast for the next six months
(to line 4 of the Withdrawal Application)
Purchases
[UN AGENCY] standard handling fee, plus any other agreed-upon
charges.

Total

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Shipping Report

Shipments in Prior Periods Quantity US Dollars

Sub-total for prior periods

Shipments in the Current Period

Sub-Total for the current period

Shipments forecasted for the next 6 months

Sub-Total for the next 6 months

Grand Total

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Signature: ______________

Name: ______________

Title: ______________

Date: ______________

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 ANNEX VI
SCHEDULE OF [UN AGENCY]’S HANDLING CHARGES FOR THE GOODS

Commodities Handling Charge (%)

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