Request Form - UNICEF - UNICEF Home

							                                              PROCUREMENT SERVICES - CUSTOMER REQUEST

TO:         psid@unicef.org
            Procurement Services Centre
            UNICEF Supply Division
            UNICEF Plads, Freeport
            DK-2100 Copenhagen O
            Denmark
            Fax: +45 3526 9421

                                                                       SECTION A: REQUESTOR
All fields in Section A are mandatory

ORGANISATION:                                                                                                                                  Type of Organisation
Contact Name:                                                                                                                                              Please select
Contact Title:                                                                                                                                             Government
Address:                                                                                                                                                   NGO
Telephone:                                                                                    Fax:                                                         UN Agency
Email:                                                                                       Date:
Project Name:
Funding Source:
Allocated Budget:


Have you previously procured via UNICEF?          Yes                                       No
If known, please specify your UNICEF customer number.

                                                              SECTION B: LIST OF REQUIREMENTS
Please refer to the UNICEF Supply Catalogue - available on-line at http://www.supply.unicef.dk/catalogue for information on the supplies you require.
If the supplies you require are not listed in the catalogue please provide detailed technical specifications.


                     UNICEF                                                                                                                    Unit
Item No.                                                                          Item Description                                                            Quantity
                 Material Number                                                                                                         (if applicable)




If extra space is required please copy extra lines or add to a spreadsheet
                                   PROCUREMENT SERVICES - CUSTOMER REQUEST

                                              SECTION C: DELIVERY INSTRUCTIONS
All fields are mandatory
Special Markings:
Requested Delivery Date

Mode of Shipment (select):              SEA                   AIR
Delivery Terms/Place: CIP Incoterms 2000               Named destination:

CONSIGNEE:
Contact Name:
Address:
P.O. Box:
City:                                                            Country:
Telephone:                                                            Fax:
Email:
UNICEF Consignee Code:                              UNICEF Customer Code:    Yes
                                            SECTION D: SUBMITTING YOUR REQUEST

TO:       psid@unicef.org
          Procurement Services Centre
          UNICEF Supply Division
          UNICEF Plads, Freeport
          DK-2100 Copenhagen O
          Denmark
          Tel: +45 3527 3527
          Fax: +45 3526 9421

For further information, please refer to the Procurement Services web pages. Available information include Frequently Asked
Questions, process flows and the supply catalogue.