WASH Certificate Pre-Qualification Form
This is an online application form for partners to obtain the WASH Sector Clearance
Email address *
Name of NGO (INGO/Local) *
Location (head Office)
Location of Sub Office(s), if any *
Required
Year of establishment in Liberia *
MM
/
DD
/
YYYY
Name of Executive Director
Form Completion Date *
MM
/
DD
/
YYYY
Telephone No *
Email, if any
WASH CONSTRUCTION EXPERIENCE *
A) Project Name, B) Funding Source, C) Implementation Period, D)Status
Briefly discuss difficulty/lessons learnt during period of works
Finance: *
Name of Bank/Account Number
Administrative Staff *
A) Name, B) Position, C) Edu. Qualification
Technical Staff
A) Name, B) Position, C) Edu. Qualification
Other Staff
A) Name, B) Position, C) Edu. Qualification
EQUIPMENT / TOOLS *
Please tick equipment/tools available for WATSAN construction works
Required
I hereby certify that the information contained herein is true and accurate to the best of my knowledge *
Required
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