Request for Quotation for Vehicles (Ev Minibus, Diesel Minibus, Ev Minivan, Plug-in Hybrid SUV & Ev SUV)

Rwanda Institute for Conservation Agriculture (RICA)

πŸ“‹ Job Summary
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Location
Kigali, Rwanda
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Job Type
Contract
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Job Sector
Procurement
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Education
Not Specified
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Positions
1
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Deadline
28/09/2026 23:59
14d 7h remaining
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About Rwanda Institute for Conservation Agriculture (RICA)
The Rwanda Institute for Conservation Agriculture is a higher education institution established in 2019 with a focus on practical agriculture. Its campus in Gashora (Bugesera) includes working farms, ...
The Rwanda Institute for Conservation Agriculture is a higher education institution established in 2019 with a focus on practical agriculture. Its campus in Gashora (Bugesera) includes working farms, classrooms, a commercial kitchen, offices and residential housing. It also maintains satellite operations at Nasho in Kirehe District (both in Eastern Province).
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πŸ‘€ Who May Be Interested

Professionals seeking career advancement and individuals with relevant qualifications may be interested in this opportunity.

This opportunity is ideal for professionals interested in the role of Request for Quotation for Vehicles (Ev Minibus, Diesel Minibus, Ev Minivan, Plug-in Hybrid SUV & Ev SUV) based in Kigali, Rwanda. Qualified and motivated candidates are encouraged to apply for this contract opportunity.
ℹ️ About This Opportunity

The position of Request for Quotation for Vehicles (Ev Minibus, Diesel Minibus, Ev Minivan, Plug-in Hybrid SUV & Ev SUV) at Rwanda Institute for Conservation Agriculture (RICA) located in Kigali, Rwanda offers an opportunity for qualified professionals to contribute their knowledge and experience in a dynamic working environment. The organization seeks individuals who are motivated, reliable, and capable of performing their duties effectively while maintaining professional standards.

⭐ Common Skills Required
  • Excel
  • Tax
  • Sales
  • Training
  • Procurement
πŸ“„ Job Description

This description has been adapted for JobNziza readers to provide a clearer overview of the opportunity.

Bid Document for Goods and Services

Title of the Tender:RFQ for Vehicles (EV Minibus, Diesel Minibus, EV Minivan, Plug-in Hybrid SUV & EV SUV)
Tender Reference Number:RICA11/08/2026
Procurement Method:Open Tender
Date of Issue:14/09/2026
Cut off Date for Queries21/09/2026
Submission Deadline:28/09/2026

1. DEFINITIONS AND INTERPRETATION

1.1 In this tender document, unless the context indicates otherwise:

  • "RICA" means the Rwanda Institute for Conservation Agriculture
  • "Bidder" means any entity submitting a bid in response to this tender
  • "Contract" means the agreement to be entered into between RICA and the successful bidder
  • "Goods" means the items to be supplied as specified in the Schedule of Requirements
  • "Services" means any related services required in connection with the supply of goods
  • "Day" means calendar day

2. INVITATION TO BID

2.1 RICA invites electronic bids from eligible bidders for the supply of Vehicles – EV Minibus (Coaster-type), Diesel Minibus (Coaster-type), EV Minivan, Plug-in Hybrid (PHEV) SUV, and EV SUV – as detailed in the Technical Specifications Sheets (Annexes A–E).

2.2 Bid Submission:

Deadline: 28/09/2026

Method: Electronic submission to tenders@rica.rw 

Format: All bids must be consolidated into a single ZIP file and submitted in English. (The ZIP file should contain all required documents, forms, and supporting materials organized in clearly labeled folders. The Zip file name should follow the convention: [YOURCompanyName]Bid[Date: YYYYMMDD].zip)

Documents within the ZIP file must be in the following formats:

Technical proposals and written documents: PDF format

Financial spreadsheets: Microsoft Excel format (.xlsx)

Completed forms: PDF format with signatures where required

Supporting documents: PDF format

The total size of the ZIP file should not exceed 30MB. For submissions exceeding 30MB, please upload your ZIP file to a secure cloud storage service (such as Google Drive, OneDrive, or Dropbox) and include the shareable link in your email to  tenders@rica.rw Ensure the link permissions are set to "View only" and remain active for at least 30 days after the submission deadline.

Upon successful submission, you will receive an automated confirmation email. If you do not receive this confirmation within one hour of submission, please contact feedback@rica.rw

3. BIDDER ELIGIBILITY

3.1 This tender is open to all qualified bidders who:

  • Are legally registered businesses
  • Have the required licenses and permits
  • Have the technical and financial capability to deliver the required goods/services
  • Are not under any procurement suspension or debarment from RICA or the Rwanda Public Procurement Agency (for local vendors)

For the full terms and conditions for eligibility, please refer to RICA Bidding Guidelines in this link https://www.rica.rw/documents/ 

3.2 Joint Ventures:

  • Are permitted with clear designation of guide partner
  • Must deliver joint venture agreement
  • All partners are jointly and severally liable

4. BID PREPARATION AND SUBMISSION

4.1 Required Documents:

Completed Bid Submission Form. (https://www.rica.rw/documents/)

  • Completed Technical Specifications Sheet (where applicable)
  • Completed Price Schedule (Annex F)
  • Company Registration Documents indicating company shareholders
  • Tax Clearance Certificate
  • Manufacturer's Authorization (where applicable)
  • Quality Certifications (where applicable)
  • References for Similar Contracts
  • Templates for required documents can be found in the annexes attached

4.2 Pricing Requirements:

  • Prices shall be quoted in Rwandan Francs (RWF)
  • Bidders shall quote two prices for each item: (i) the Duty-Free Price, and (ii) the Price Inclusive of All Duties and Taxes (VAT, import duty, etc.)
  • All quoted prices shall include delivery to RICA, Gashora Campus, Bugesera District
  • Prices shall remain fixed for the duration of the contract
  • Detailed breakdown of prices must be provided for both pricing options above
  • Prices shall be submitted using the Price Schedule Template at Annex F
  • Full terms and conditions of pricing requirement can be found in RICA Bidding Guidelines

4.3 Technical Requirements:

  • Full compliance with the specifications in the Technical Specification Sheets (Annexes A–E)
  • Clear statement of delivery timeframes
  • After-sales service provisions
  • Quality assurance measures

5. BID EVALUATION CRITERIA

Below is a summary of bid evaluation criteria. For a more detailed explanation, please refer to https://www.rica.rw/documents/

5.1 Preliminary Examination:

  • Verification of eligibility documents
  • Completeness of bid
  • Compliance with submission requirements

5.2 Technical Evaluation:

  • Compliance with technical specifications
  • Quality standards
  • Delivery timeline
  • After-sales service capability
  • Experience and track record

5.3 Financial Evaluation:

  • Total bid price
  • Price breakdown analysis
  • Payment terms
  • Financial capability

6. SCHEDULE OF REQUIREMENTS

Detailed specifications of the required vehicles are provided in Annexes A–E (Technical Specification Sheets for the EV Minibus, Diesel Minibus, EV Minivan, Plug-in Hybrid (PHEV) SUV and EV SUV).

7. CONDITIONS OF CONTRACT / PURCHASE ORDER

7.1 Award of Contract / Purchase order:

  •  RICA will award the contract / purchase order to the bidder whose bid offers the best value
  • RICA reserves the right to accept or reject any bid
  • The successful bidder will be notified in writing

7.2 Contract / Purchase Order Terms:

  • Duration: Up to delivery of the goods
  • Payment Terms: Within 45 days of accepted delivery
  • Delivery Location: RICA Campus, Bugesera District, Gashora Sector


8. ANNEXES

  • Annex A: EV Minibus – Technical Specification Sheet
  • Annex B: Diesel Minibus – Technical Specification Sheet
  • Annex C: EV Minivan – Technical Specification Sheet
  • Annex D: Plug-in Hybrid (PHEV) SUV – Technical Specification Sheet
  • Annex E: EV SUV – Technical Specification Sheet
  • Annex F: RICA Price Schedule Template (Vehicles – to include both Duty-Free and Duty-Inclusive prices)

For any clarifications, contact:

Rwanda Institute for Conservation Agriculture

Bugesera District, Rwanda

Please indicate “Procurement Question” followed by Tender reference number in subject line

Email: feedback@rica.rw

ANNEX A: EV MINIBUS – TECHNICAL SPECIFICATION SHEET

This refers to a mid-size, Coaster-type passenger bus (i.e. similar in size, configuration, and body style to the Coaster or equivalent).

Bidders must state their offered specification against each item in their technical proposal and confirm compliance with the minimum requirement below.

No.Specification ItemMinimum/Required SpecificationUnit
A. Vehicle Type & Body
1MakeLatest model-
2Seating capacity30 Seatsseats
3Tyre size215/75R17.5-
4Body dimensions (L x W x H)State exact dimensions offeredmm
5Exterior colour optionsState available body colour options-
B. Performance
6Maximum speedMinimum 80km/h
7Motor power outputState total power offeredkW
8Engine torque outputState maximum torque offeredN·m
9GradeabilityState maximum gradient the vehicle can climb%
C. Battery, Range & Charging
10Battery continuous mileageMinimum 300km
11Battery capacityState battery capacity offeredkWh
12Charging time (DC fast charge)State fast-charge duration offeredhours
13Charging time (AC standard charge)State standard charge duration offeredhours
14Charging interface/connectorState charging standard offered-
D. Chassis, Suspension, Steering & Braking
15Drive typeLeft Hand Drive (LHD)-
16Steering systemHydraulic power steering-
17Suspension systemState front/rear suspension type offered-
18Braking systemABS with EBD-
19Ground clearanceState minimum ground clearance offeredmm
E. Safety Systems
20ABS+EBDABS+EBD-
21Fire suppression systemRequired-
22Emergency exits/windowsRequired, state number and location-
23Reverse camera/parking sensorsRequired-
24Driver & Front Passanger safety beltsOrdinary three-point type-
25Passenger beltsTwo-point belts-
F. Interior & Comfort
26Air conditioningRoof-mounted electric AC system-
27Seat typeCushioned, adjustable-
28Interior/exterior lightingRequired, state the types offered-
G. Warranty, Compliance & After-Sales
29Vehicle warrantyState minimum period offeredyears/km
30Battery warrantyState minimum period/km offeredyears/km
31After-sales service networkAvailability of authorized service center(s) in Rwanda-
32Spare parts availabilityLocal availability, minimum stocking commitment-
33Delivery lead timeState maximum delivery period from date of orderweeks

ANNEX B: DIESEL MINIBUS – TECHNICAL SPECIFICATION SHEET

This refers to a mid-size, Coaster-type passenger bus (i.e. similar in size, configuration, and body style to the Coaster or equivalent).

Bidders must state their offered specification against each item in their technical proposal and confirm compliance with the minimum requirement below.

No.Specification ItemMinimum/Required SpecificationUnit
A. Vehicle Type & Body
1MakeLatest model-
2Seating capacity30 Seatsseats
3Tyre size215/75R17.5-
4Body dimensions (L x W x H)State exact dimensions offeredmm
5Exterior colour optionsState available body colour options-
B. Performance
6Maximum speedMinimum 80km/h
7Engine power outputState maximum power offeredkW/hp
8Engine torque outputState maximum torque offeredN·m
9GradeabilityState maximum gradient the vehicle can climb%
C. Engine & Fuel System
10Engine typeDiesel, turbocharged, state number of cylinders offered-
11Engine displacementState engine displacement offeredcc/litres
12Fuel tank capacityState fuel tank capacity offeredlitres
13Fuel consumptionState average fuel consumption offeredkm/l
14Cooling systemWater-cooled with radiator-
D. Chassis, Suspension, Steering & Braking
15Drive typeLeft Hand Drive (LHD)-
16Steering systemHydraulic power steering-
17Suspension systemState front/rear suspension type offered-
18Braking systemABS with EBD-
19Ground clearanceState minimum ground clearance offeredmm
E. Safety Systems
20Fire suppression systemRequired-
21Emergency exits/windowsRequired, state number and location-
22Driver & Front Passanger safety beltsOrdinary three-point type-
23Passange SeatbeltsTwo-point belts-
F. Interior & Comfort
24Air conditioningRoof-mounted AC system-
25Seat typeCushioned, adjustable-
26Interior/exterior lightingLED headlights, taillights, and interior lighting-
G. Warranty, Compliance & After-Sales
27Vehicle warrantyState minimum period offeredyears/km
28Engine warrantyState minimum period/km offeredyears/km
29After-sales service networkAvailability of authorized service center(s) in Rwanda-
30Spare parts availabilityLocal availability, minimum stocking commitment-
31Delivery lead timeState maximum delivery period from date of orderweeks

ANNEX C: EV MINIVAN – TECHNICAL SPECIFICATION SHEET

Bidders must state their offered specification against each item in their technical proposal and confirm compliance with the minimum requirement below.

No.Specification ItemMinimum/Required SpecificationUnit
A. Vehicle Type & Body
1MakeLatest Version-
2Body colourWhite-
3Door configuration4 Door with 1 sliding door-
4Seating/Load capacity16+1 seats (state exact seating configuration offered)seats
B. Performance (Motor)
5Rated/Max PowerMore than or equal to 60/120kW
6Rated/Max TorqueMore than or equal to 160/350N·m
C. Battery, Range & Charging
7Battery continuous mileageMore than or equal to 300km
8Charging portB-pillar charging ports (slow on the left and fast on the right)-
9Auxiliary battery (12V system)Maintenance-free lead-acid battery (60Ah, 12V)-
D. Chassis/Suspension/Steering & Braking
10Drive typeLeft Hand Drive (LHD)-
11BrakeFront Disc / Rear Drum-
12Rear axle ratioState exact rear axle ratio offered-
13TyreMore than or equal to 205/65R15-
14Ground clearanceState minimum ground clearance offeredmm
E. Safety Systems
15ABS+EBDABS+EBD-
16Fire suppression systemRequired-
17Emergency exits/windowsRequired, state number and location-
18Reverse camera/parking sensorsRequired-
19Driver & Front Passanger safety beltsOrdinary three-point type-
20Passenger beltsTwo-point belts-
F. Interior & Comfort
21Seat arrangement16+1 seats, middle co-driver seat (state exact seating configuration offered)-
22A/C (air conditioner)Front AC-
23HeaterFront Heater-
24Interior/exterior lightingRequired, state the types offered-
G. Warranty, Compliance & After-Sales
25Vehicle warrantyState minimum period offeredyears/km
26Battery warrantyState minimum period/km offeredyears/km
27After-sales service networkAvailability of authorized service center(s) in Rwanda-
28Spare parts availabilityLocal availability, minimum stocking commitment-
29Delivery lead timeState maximum delivery period from date of orderweeks

ANNEX D: PLUG-IN HYBRID (PHEV) SUV – TECHNICAL SPECIFICATION SHEET

This refers to a plug-in hybrid electric vehicle (PHEV) SUV – i.e. a vehicle with both an internal combustion engine and a high-voltage battery that can be recharged from an external power supply. Conventional (non plug-in) hybrids and mild hybrids will not be accepted under this Annex.

Bidders must state their offered specification against each item in their technical proposal and confirm compliance with the minimum requirement below.

No.Specification ItemMinimum/Required SpecificationUnit
A. Vehicle Type & Body
1MakeLatest Version-
2Body colourState available exterior colour options-
3Seating capacity6-7 Seats (e.g. 2+2+2 or 2+3+2 configuration)seats
4Body dimensions (L x W x H)State exact dimensions offeredmm
5WheelbaseState wheelbase offeredmm
6Boot/cargo volumeState minimum and maximum cargo volume offeredlitres
B. Performance
7Maximum speedMore than or equal to 170km/h
8Total system power (engine + electric motor)More than or equal to 120kW
9Total system torqueState combined torque offeredN·m
10Powertrain configurationPlug-in hybrid electric (PHEV) – internal combustion engine plus externally rechargeable electric motor(s)-
C. Engine, Battery, Range & Charging (Plug-in Hybrid)
11Battery capacity (usable, externally rechargeable)More than or equal to 40kWh
12Total range (combined)More than or equal to 1100km
13Electric-only rangeMore than or equal to 100 (state test cycle applied, e.g. WLTP/CLTC)km
14Charging time (DC fast charge, 10-80%)Less than or equal to 30minutes
15Charging time (AC standard charge, 0-100%)Less than or equal to 4hours
16Fuel tank volumeMore than or equal to 60litres
17Fuel gradeMinimum RON 92-
18Engine type & displacementPetrol, state displacement and number of cylinders offeredcc/litres
19Charging interface/connectorState charging standards offered (e.g. Type 2 AC and CCS2 DC)-
20Charging equipment suppliedBattery rechargeable from an external AC and DC supply; portable AC charging cable and wall-box charger to be supplied with each vehicle-
D. Chassis/Suspension/Steering & Braking
21Suspension systemFront and rear independent suspension with continuously variable damping-
22Braking systemFront ventilated disc / Rear ventilated disc with EPB-
23Tyre & rim sizeState tyre and alloy rim size offered-
24Drivetrain (wheel drive system)State drivetrain configuration offered (2WD / 4WD / AWD)-
25Drive modesMultiple selectable drive modes (e.g. Eco/Comfort/Sport/Snow/Off-road)-
E. Safety Systems
26AirbagsMinimum 6 airbags (front, side, curtain)-
27ABS+EBDRequired-
28Electronic Stability Control (ESC)Required-
29Driver assistance systemsRequired (e.g. lane keep assist, blind spot detection, forward collision alert, rear cross-traffic alert)-
30Parking assist360° camera with ultrasonic radar and automatic parking assist-
31ISOFIX child seat interfaceRequired-
F. Interior & Comfort
32Seat adjustmentPower-adjustable front seats with heating/ventilation-
33Climate controlMulti-zone automatic climate control with rear vents-
34Infotainment/displayDigital instrument cluster and central touchscreen display, state sizes offered-
35ConnectivitySmartphone mirroring (e.g. CarPlay/Android Auto), Bluetooth, wireless charging-
G. Warranty, Compliance & After-Sales
36Vehicle warrantyState minimum period offeredyears/km
37High-voltage battery warrantyState minimum period/km offered and minimum guaranteed battery state of healthyears/km
38After-sales service networkAvailability of authorized service center(s) in Rwanda-
39Spare parts availabilityLocal availability, minimum stocking commitment-
40Delivery lead timeState maximum delivery period from date of orderweeks

ANNEX E: EV SUV – TECHNICAL SPECIFICATION SHEET

Bidders must state their offered specification against each item in their technical proposal and confirm compliance with the minimum requirement below.

No.Specification ItemMinimum/Required SpecificationUnit
A. Vehicle Type & Body
1MakeLatest Version-
2Body colourState available exterior colour options-
3Seating capacity6-7 Seats (e.g. 2+2+2 or 2+3+2 configuration)seats
4Body dimensions (L x W x H)State exact dimensions offeredmm
5WheelbaseState wheelbase offeredmm
6Boot/cargo volumeState minimum and maximum cargo volume offeredlitres
B. Performance
7Maximum speedMore than or equal to 170km/h
8Total motor power outputMore than or equal to 120kW
9Total motor torqueState combined torque offeredN·m
C. Battery, Range & Charging (Battery Electric)
10Battery capacity (usable)More than or equal to 60kWh
11Battery typeState battery chemistry offered (e.g. LFP or NMC)-
12Electric range (combined)More than or equal to 400 (state test cycle applied, e.g. WLTP/CLTC)km
13Charging time (DC fast charge, 10-80%)Less than or equal to 30minutes
14Charging time (AC standard charge, 0-100%)Less than or equal to 8hours
15Charging interface/connectorState charging standards offered (e.g. Type 2 AC and CCS2 DC)-
16Charging equipment suppliedPortable AC charging cable and wall-box charger to be supplied with each vehicle-
D. Chassis/Suspension/Steering & Braking
17Drive type & drivetrainLeft Hand Drive (LHD); state drivetrain configuration offered (2WD / 4WD / AWD)-
18Suspension systemFront and rear independent suspension with continuously variable damping-
19Braking systemFront ventilated disc / Rear ventilated disc with EPB, including regenerative braking-
20Tyre & rim sizeState tyre and alloy rim size offered-
21Drive modesMultiple selectable drive modes (e.g. Eco/Comfort/Sport/Snow/Off-road)-
E. Safety Systems
22AirbagsMinimum 6 airbags (front, side, curtain)-
23ABS+EBDRequired-
24Electronic Stability Control (ESC)Required-
25Driver assistance systemsRequired (e.g. lane keep assist, blind spot detection, forward collision alert, rear cross-traffic alert)-
26Parking assist360° camera with ultrasonic radar and automatic parking assist-
27ISOFIX child seat interfaceRequired-
F. Interior & Comfort
28Seat adjustmentPower-adjustable front seats with heating/ventilation-
29Climate controlMulti-zone automatic climate control with rear vents; heat-pump system preferred-
30Infotainment/displayDigital instrument cluster and central touchscreen display, state sizes offered-
31ConnectivitySmartphone mirroring (e.g. CarPlay/Android Auto), Bluetooth, wireless charging; state vehicle-to-load (V2L) output offered-
G. Warranty, Compliance & After-Sales
32Vehicle warrantyState minimum period offeredyears/km
33High-voltage battery & electric motor warrantyState minimum period/km offered and minimum guaranteed battery state of healthyears/km
34After-sales service networkAvailability of authorized service center(s) in Rwanda with EV-trained technicians-
35Spare parts availabilityLocal availability, minimum stocking commitment-
36Delivery lead timeState maximum delivery period from date of orderweeks

ANNEX F: RICA PRICE SCHEDULE TEMPLATE (VEHICLES)

Bidders must complete this Price Schedule in full and submit it in Microsoft Excel format (.xlsx) as well as signed PDF. All prices shall be quoted in Rwandan Francs (RWF) and shall include delivery to RICA, Gashora Campus, Bugesera District. For every item, bidders must quote both (i) the Duty-Free Price and (ii) the Price Inclusive of All Duties and Taxes (VAT, import duty, withholding and any other applicable levies). Prices shall remain fixed for the duration of the contract. Where an item is not offered, enter “N/A” – do not leave cells blank.

Table F.1 – Vehicles

No.Item descriptionAnnex ref.QtyUnit price Duty FreeTotal Duty FreeUnit price Duty Incl.Total Duty Incl.
1EV Minibus (Coaster-type), 30 seatsAnnex A1    
2Diesel Minibus (Coaster-type), 30 seatsAnnex B1    
3EV Minivan, 16+1 seatsAnnex C1    
4Plug-in Hybrid (PHEV) SUV, 6-7 seatsAnnex D1    
5EV SUV, 6-7 seatsAnnex E1    
Subtotal – Vehicles       

Table F.2 – Related items and services (quote where offered)

No.Item descriptionUnitQtyUnit price Duty FreeTotal Duty FreeUnit price Duty Incl.Total Duty Incl.
6Wall-box AC charger, supplied and installedper unit     
7Portable AC charging cableper unit     
8DC fast charger, supplied and installed (if offered)per unit     
9Extended vehicle warranty beyond standard (state period offered)per vehicle     
10Extended high-voltage battery warranty (state period offered)per vehicle     
11Scheduled maintenance package (state duration/mileage covered)per vehicle     
12Registration, number plates and statutory first-year costsper vehicle     
13Driver and maintenance-technician training on EV/PHEV systemslump sum     
14Recommended spare parts and consumables package (attach itemised list)lump sum     
Subtotal – Related items and services       

Table F.3 – Bid price summary

DescriptionAmount Duty FreeAmount Duty Incl.
Subtotal – Vehicles (Table F.1)  
Subtotal – Related items and services (Table F.2)  
TOTAL BID PRICE  
Of which VAT (18%)N/A 
Of which import duty and other leviesN/A 
Total bid price in words (duty-inclusive)  

Notes to bidders

  • Quantities shown in Tables F.1 and F.2 are as stated by RICA in this tender; bidders shall not vary them.
  • Duty-Free prices are for RICA's use in assessing exemption-based procurement; the Price Inclusive of All Duties and Taxes must show the full landed cost payable if no exemption applies.
  • A detailed breakdown of each price (ex-works or FOB value, freight, insurance, clearing, inland transport, duties, VAT, margin) must be attached for both pricing options, as required by clause 4.2.
  • Prices shall remain valid for a minimum of ninety (90) days from the submission deadline and fixed for the duration of the contract.
  • Payment terms are within forty-five (45) days of accepted delivery, in accordance with clause 7.2. Any alternative payment terms proposed must be stated separately and may affect evaluation.
  • Where a vehicle is offered in more than one variant, submit a separate copy of this Price Schedule for each variant, clearly labelled.

Bidder's declaration

I confirm that the prices quoted above are complete, include delivery to RICA, Gashora Campus, Bugesera District, and are valid for the period stated. I further confirm that the vehicles offered comply with the technical specifications in Annexes A–E.

Name of authorised representative: ________________________________

Position / title: ________________________________

Name of bidding company: ________________________________

Signature: ________________________________

Company stamp: ________________________________

Date: ________________________________

 


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