NPI - REQUEST FOR INFORMATION FORM.docx

New Partnerships Initiative – Request for Information (RFI) RFI Number: USAIDPakistan-NPI-RFI-2020-001

Attachment-A

NPI - REQUEST FOR INFORMATION FORM

A. ORGANIZATIONAL INFORMATION:

Name of Organization: _________________________________________________

Office Address: _________________________________________________

City: _________________________________________________

Province/Postal Code: _________________________________________________

Telephone Number: _________________________________________________

E-mail Address: _________________________________________________

Website address (if any): _________________________________________________

Authorized Person / Point of Contact (Name): ________________________________

Contact Number: _________________________________________________

Title: _________________________________________________

E-mail Address: _________________________________________________

B. REGISTRATION INFORMATION:

a. Type of Organization:

Profit: ____________ Non-for-profit: _________________

b. Category of Organization as per NPI definitions (Please see Attachment-B for the definitions)

New Partner: _____________ Underutilized Partner: _____________

Local Entity: _____________ Locally Established Partner: _____________

c. Registration Authority: ____________________________________________________

Address of Registration Authority: ____________________________________________

Validity Period of Registration: ____________

If registration is only valid to operate in certain geographical locations in Pakistan, please specify those geographical locations.

(Note: Please attach copy of your organization’s registration documents)

C. GEOGRAPHICAL LOCATION

9. Geographical Location of Organizational Head Office:

10. Geographical Location of Field Offices (if any):

D. FUNDING INFORMATION:

Please list the ongoing / completed projects during the last five (05) years (if applicable).

(PKR)

Amount

(USD)

From (d/m/y) To (d/m/y)

Note: If the above space is not enough to list down all the requested information, please attach a separate list of your projects with the same level of details requested in the above table.

E. FIELD OF EXPERTISE

Please check all that apply.

Name: ____________________

Signature: ____________________

Authorized Representative of the Organization