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 WASH Common Pipeline Request (CPR) Form v4
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Instructions: Please use this form for all requests for items from RUWASA and WASH Sector.
By signing the CPR, the organization undertakes to follow the SOPs (guide, flow cart, reporting) available on the WASH sector website.		CPR # Issued by WASH Sector
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Common Pipeline.
1. All fields marked with asterisk (*) are mandatory
2. Please send your completed Common Pipeline Request Form to: joseph.waithaka@nrc.no		Request Date (dd/mm/yy) *
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Section 1 - Requestor InformationSection 2-Allocation
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Date*Funding source*
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Requesting Organization*Section 3 Project Information
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Name of Requestor*Response Type*
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Position*Site Location* and Type*
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Phone*Est. # individuals*
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Email*Beneficiary Type*
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Other contact detailsReport due date (dd/mm/yy)*
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Items Requested
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Instructions: To request items, agencies should (i) confirm in their email that the WASH Sector LGA focal point is OK, (ii) check if the requested supplies are available in the online stock on the WASH Sector website, (iii) provide any additional justification (see box below) if no assessment has been shared with the CPR.
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SN*Category*Description*Unit/ Packaging*Quantity*Total Gross wt (kg)Total volume (m3)Warehouse location* (State/Town)CP Agency* (UNICEF or IOM or Goalprime)
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Transport
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Instructions: As stated in the Guideline on Common Pipeline release of WASH supplies to partners, all agencies must cover the transportation and loading costs from the warehouse to the distribution point.
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Section 5 Justification for Request (for the request of Top-Up kit only, justification is not required)
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Date of Assessment (DD/MM/YYYY)*Assessment conducted by*
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Is the assessment report attached*If no, why?
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Additional justification* (calculation of the quantities of supplies requested based on the number of vulnerable people targeted, WASH-related accute vulnerabilities if no assessment has been shared, etc.):
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Sector 6 Response Details
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Prefered Date for goods to pick up
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Distribution plan confirmed in the sector response plan?
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Is this distribution plan updated in WASH Sector 5W?
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Requested by*:                              Approved by:                                                       
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Title*:                                                                   Title: WASH Sector LGA Focal Point (Borno State)
or State Focal Point (Adamawa or Yobe State)
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Signature*: Signature:                                                          Date:
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Approved by:                                                       
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Title: WASH Sector Coordinator/Co-Coordinator
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Signature:                                                          Date
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