ANNEX I:

TERMS OF REFERENCE FOR FOOD QUALITY AND QUANTITY INSPECTION AND

LABORATORY TEST SERVICES:
1. Background:
The United Nations World Food Programme Mozambique CO (WFP) procures different food
commodities through the use of tenders, from various different suppliers, under various
consignments, for various different destinations, and under different and unique INCOTERMS for
each purchase. Prior to WFP accepting ownership of the food commodities procured, all food
commodities must undergo a food quality and quantity inspection which is to be conducted by the
well qualified and experienced food quality & quantity inspectors.
It is estimated that during the Six-month (6) period, WFP will procure about 5,000 MT of food to
be inspected for both quality and quantity.
2. Required Services (Scope of Work)
The required food inspection AND laboratory analysis services shall be performed in accordance
with internationally accepted sampling and analysis procedures and shall include:
2.1 Inspection at the Suppliers Warehouse:
The inspection at the suppliers warehouse prior to the loading and shall consist of:
A- Premises:
1. The Food Inspector(s) shall inspect the suppliers warehouses to determine the condition,
hygiene and suitability for accomplishing the food supply contract.
B- Packaging
2. Visual check for quality of packaging materials.
3. For bag packed: Bag drop test for 10% of the tonnages of the commodity.
4. Sample weighing of a minimum of 10% of the total tonnages of the food commodity must be
done to ensure that weights conform to the contract. Where necessary a higher percentage of
samples may be used to determine the average weight. For a representative sampling, the units
of food commodities must be picked from the front, middle, and the back locations in the
container.
5. Check the weights of full and empty packaging as per specification.
6. Check the markings on the packaging as per requirements.
7. Some bags must be opened up to ensure that:
o There are no live pests inside bags.
o Evidence of high moisture (e.g. caking, darkening, etc.)
o Other visual defaults must be reported (e.g. presence of foreign matters in excessive
quantities, etc.)
8. Any identified problem of packaging (such as weak packaging, torn, old, or unserviceable or
with poor quality stitching/sealing) and of the goods must be reported to WFP office.
C- Sampling
9. Representative samples to be drawn according to international sampling method standards.
Sampling frequency and reference method are shown in Table 1.
10. A retention sample (of the same size of the lab sample) (of the same size of the lab sample)
MUST be retained by the food inspection for no less than 3 months.
D- Pictures

11. Take pictures of commodities and warehouse (attached these pictures to the inspection report).
The pictures must be taken with an appropriate resolution (Min. 2 Megapixel). However, if
sent to WFP by e-mail, VGA size should be used.
A checklist is available at:
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tabi
d/500/Default.aspx
2.2 Inspection during production (for processed foods, e.g. Fortified Blended Foods,
Fortified Wheat Flours, Biscuits, etc.)
1.

2.
3.
4.

5.
6.

A- Presence
The Food Inspector(s) must be present during production of processed foods, whenever work
is in progress.
B- Various controls
Visually check the quality of the raw materials (e.g. foreign matters for grains and pulses, Best
Use Before Date of ingredients, etc.)
Visually check the infestation, discoloration, moisture content of raw materials, etc.
Follow the fortification procedure
(Available at:
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tabi
d/500/Default.aspx )
o Premix (storage, Certificate of Analysis, Proof of purchase, etc.)
o Feeder (calibration, Coefficient of Variation, etc.)
o Records (Calibration, premix inventory, premix usage, etc.)
Take pictures of the different production posts (in case of abnormalities).
C- Sampling
Representative samples can be drawn according to international sampling method standards
during production, at the bagging section. Sampling frequency and reference method are
showed in Table 1.

If an automated sampling device is available in the factory, if the frequency of sampling is equal
or higher than recommended by WFP, then the sample can be drawn from the device.
For Aflatoxin SAMPLING and TESTING, a specific procedure must be followed; this procedure
is available on-line at:
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tabid/5
00/Default.aspx
Table 1: Sampling rules
No

Commodities

CSB
Maize Meal

Lot or
sub-lot
size (MT)
15
16 30
31 45

Number of increment
3 (One increment every 5
MT)
8 (One increment every 2
MT to 3.7 MT)
11 (One increment every
2 .8 MT to 4.1 MT)

Place of
sampling

Reference

Plant, during
production.

ISO 243332009

P a g e 2 | 19

46 100

HEB, SALT,
SUGAR

50
51 100

100

101-200

Wheat flour
Wheat Bulgur
Pulses
Maize

201-300

301-400

3 % of bags (e.g. 240

increments for a lot of
400 MT, packed in 50
kg)

100

101-200
4

50 (One increment every

0.1 to 1 MT)
50 (One increment every
1 to 2 MT)
3 % of bags and
minimum 50 bags (e.g.
60 increments for a lot of
100 MT, packed in 50
kg)
3 % of bags (e.g. 120
increments for a lot of
200 MT, packed in 50
kg)
3 % of bags (e.g. 180
increments for a lot of
300 MT, packed in 50
kg)

401-500

Vegetable oil
Rapeseed oil
Soybean oil
Sunflower oil
Palmolein oil

15 (One increment every

3.0 MT to 6.6 MT)

201-300
301-400
401-500

3 % of bags (e.g. 300

increments for a lot of
500 MT, packed in 50
kg)
3 increments per tank
or 20 40 cans per every
n cans
3 increments per tank
or 45 cans per every n
cans
3 increments per tank
or 55 cans per every n
cans
5 increments per tank
or 65 cans per every n
cans
6 increments per tank
or 75 cans per every n
cans

Warehouse

ISO 243332009

Warehouse or
during
production

GAFTA
124-2

Plant
(sampling in
tank)
or Warehouse
(sampling from
packages)

ISO 55552001
(FOSFA /
2002)

7. A retention sample (of the same size of the lab sample) MUST be retained by the food
inspection for no less than 3 months.
A checklist is available at:
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tabi
d/500/Default.aspx
2.3 Inspection at Loading Point
P a g e 3 | 19

A- Presence
a) The food inspector(s) must be present at each place of loading, whenever work is in progress.
b) If the cargo has been inspected at the warehouse level or at the factory level, a system of
sealing, identification, etc. of the cargo MUST be put in place. The identification system must
be documented and shared with WFP. The inspection company will be liable for the status of
the cargo until the title of property is passed on to WFP.
B- Visual check of cargo and means of transportation
a) Visually check again the packaging (quality, stitching, marking, weight) to ensure that the
goods are in conformity with the contract.
b) Further visual checking for infestation, discoloration, moisture content etc.
c) Inspect the trucks / vessel / container (or any mean of transportation) before loading to ensure
they are clean and fit for transportation of food (e.g. no risk of contamination from oil / fuels
or other contaminants that may have been previously carried, etc.), and ensure the containers,
the floors of the truck bodies are sound.
d) Follow the loading procedure of containers
e) (Available at:
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tab
id/500/Default.aspx )
f) Take pictures of empty trucks, containers, etc.
g) If fumigation is required, the inspection company must advise the supplier to follow WFPs
fumigation SOP and must report on the fumigation. (SOP is available at
http://foodquality.wfp.org/Portals/0/Fumigation%20SOP%20WFP.swf )
C- Tallying
a) Make a tally of all the bags/ bottles/ boxes loaded onto the truck, containers, vessels, or wagon
at the loading point.
b) Send a copy of the tally sheet with the loading truck/vessel to be presented at the offloading
point.
c) For loaded Truck, the inspector will accurately complete a truck waybill (Waybill booklet will
be provided by WFP). The inspector will first verify with WFP for the correct Truck before
loading (the inspector must ensure that he/she has received from WFP the list of trucks
scheduled for loading and only trucks listed in the schedule should be loaded). The completed
truck waybill must be signed by both the inspector and the Truck driver (transporter).
d) The inspector will give the right copy of the completed and signed Truck waybill to the
Transporter, the supplier, WFP, etc as indicated in Waybill booklet.
e) Daily report with photographs.
D- Reporting
Inspection Company must fill the check list of inspection (available at:
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tabid/5
00/Default.aspx )
3. Analysing the Samples and Reporting
A- Laboratory Choice
Samples collected at suppliers warehouse, plant, or during loading shall be analysed (the list of
analyses in annex IV) either at food inspection company laboratory or at a subcontracted
laboratory. Ideally the laboratory needs to be ISO 17025 accredited.
Inspection Company must inform WFP which laboratory will carry out the analysis. Name, contact details,
accreditation of the lab MUST be sent to WFP as part of the offer. The inspection company and subcontracted

P a g e 4 | 19

laboratory(ies) which have not yet completed the corresponding WFP survey questionnaire must complete it as part
of the response to this tender (see attached document Annex VI)
WFP will guide the inspection company on the final choice of the lab.

Several times in the year, WFP will sample and analyse food in a reference laboratory of its
choice in order to cross-check the accuracy of the laboratory used by the inspection company.
B- Results
The analysis results for each batch depending on the contracted quantity and pending issuance of a
final Food inspection certificate after the conclusion of the contract. Methods of analysis
(standards) and sampling protocol must be mentioned in the analysis report.
C- Reporting
Inspection company shall provide the following certificates.
Fortification (for fortified food only) and quality of the raw materials
a) Certificate of Analysis of the Premix (with all minerals and vitamins analysed)
b) Proof of purchase of the premix (quantities, origin, etc.) and it MUST be checked to
ensure the premix come from a WFPs approved supplier and has been ordered in the right
quantity.
c) A statement on the quality of the raw materials and it suitability for the production of the
processed product for human consumption.
Inspection reports (for all commodities)
d) A sampling report (with location of sampling, quantity sampled, name of the inspector
who did the sampling, quantity sampled, etc.)
e) A lab (or visual check) report (Certificate of Analysis COA) from a WFP pre-approved
lab (i.e. final certificate as well as intermediate certificates will be required).
f) Daily reports to inform the WFP procurement Officer on the progress of the operation.
g) Inspection at loading (including tallying and loading report, see loading procedure at
http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/
tabid/500/Default.aspx The inspector will complete and sign a truck waybill.
Additional documents
h) Fumigation report (if fumigation is required: fumigant type, quantity / MT, exposure
duration, place of fumigation)
i) All other supporting documents, records, photos, information related to the reports and
checklists (refer to contract for more information, e.g. transport documentation)
Payment to your company will be done ONLY if the whole set of documents, records, etc. is
provided to WFP.
A checklist is available at:

P a g e 5 | 19

http://foodquality.wfp.org/QualityProcedures/StandardOperationProceduresandGuidelines/tabid/5
00/Default.aspxAnnex II: The United Nations general Conditions of contracts
General terms (see attached PDF document under titled UN- general condition services)

P a g e 6 | 19

Annex III: ENDORSEMENT LETTER

Ref. No: .

The ..................................................................[NAME OF THE COMPANY] is committed

to sampling, analysing food products that are recognized by WFPs beneficiaries as high quality,
safe and wholesome. To this end, WFP has always considered Food Quantity and Quality
Inspection Company as a partner of our organization; thus, require your company to achieve the
high standards set by ourselves on behalf of our beneficiaries. We must ensure that all our partners
comply with fundamental criteria and provide a vehicle to further strengthen our relationships.
We understand and agree with the REQUEST FOR PROPOSALS terms and conditions,
and scope of work. We have read all annexes (I to VI) of the present document. We have answered
to Annexes III IV and VI completely.
We understand that if this quotation is accepted, we will be in position to offer the required
services as soon as the contract is awarded to us.
We understand that WFP shall not be liable for any expenses incurred by us in the
preparation of this proposals.
We agree that the rates we offered are to be fixed and valid from the date of submission of
the proposals and not subject to variation throughout the contract period.
We understand that if our performance is well rated, the contract is extendable for an
additional one (2) months.

Date:

Name:

...

Title:

Signature:

.....
(Name of Firm and official stamp).
P a g e 7 | 19

P a g e 8 | 19

Annex III: INSPECTION & TESTING QUOTATION (FINANCIAL PROPOSAL)

Note: given that the contract will be for a period of 6 months, please explicitly confirm that
the prices will be held for the 6 months of the initial contract duration, and also the potential
3 months extension once agreed by both parties, pending confirmation of good performance.
Complete the tables in this Annex with your prices and submit together with other
documents for your quotation.
1. Inspection
Table 1: Prices for Inspection and Sampling (please provide an accurate quote that takes into
account the number of samples needed by WFP for each type of food commodity)
Commodity
Corn Soya Blend (CSB+)
Fortified Maize Meal
Maize Grains
Pulses
Salt
Refined Vegetable Oil

Rate PER MT (USD/MT)

2. Testing cost per commodity

Table 2: Analysis Prices (please provide an accurate quote for each type of food)
Commodity
Corn Soya Blend
Fortified Maize Meal
Maize
Pulses
Salt
Refined Vegetable Oil

Rate per Sample

(USD/sample)

3. Testing detailed parameters (in grey are analysis that are optional or required by certain
destination countries)
Table 1: Laboratory Analysis Charge for CSB Plus:
USD_______/ Sample (Average cost for Compulsory and Optional Analysis)
P a g e 9 | 19

No Parameter

Reference method*

Moisture

ISO 712: 2009

Protein

Fat

AOAC 981.10;
AACC 46-13
ISO 20483:2006
AOAC 954.02;
ISO 11085:2008

Crude Fibre

Peroxide value

Urease index

Particle size

8
9

Organoleptic (smell, taste,

colour)
Viscosity (Bostwick flow rate)

10

Vitamin A

11

Iron

12

Calcium

13

Potassium

14

Total aflatoxin (B1+B2+G1+G2)

15

Mesophyllic aerobic bacteria

16
17
18

Coliforms
Salmonella
E. coli

19
20

Staphylococcus
Bacillus cereus

21

Yeasts and moulds

22

GMO

23

Heavy metals

Rate per
sample
(USD/sample)

Lead Time
required to
submit
results
(days)**

AOAC 992.16
AOAC 985.29
AOAC 965.33
AOCS Ba 9-58
(1997)
AACC 66-20

Mouquet & Treche,

2006
AOAC 992.04;
AACC 86-03
AOAC 944.02;
AACC 40-41B
AOAC 984.27;
AOAC 944.03
AOAC 984.27;
AOAC 985.35
AOAC 972.26;
AACC 45-16;
ISO 16050
ICC No 125;
AACC 42-11
AOAC 2005.03
AACC 42-25B
AOAC 991.14
ISO 166493:2005
AACC 42-30B
AOAC 980.31
ICC No 146
AACC 42-50
ISO 24276-2006;
ISO 21571-2005
ISO 11212-1, 2, 3,
4_1997
AOAC 970.52

24 Pesticide Residues
* Or equivalent
** Working days needed for performance of the analysis

P a g e 10 | 19

Table 2: Laboratory Analysis Charge for fortified MAIZE MEAL

USD_______/ Sample (Average cost for Compulsory and Optional Analysis)
No Parameter

1
2

Reference method*

Lead Time
required to
submit results
(days)**

Rate per
sample
(USD/sample)

Moisture content
Fat

ISO 712: 2009

AOAC 954.02;
ISO 11085:2008
3
Crude fiber
AOAC 992.16
AOAC 985.29
4
Mesophyllic aerobic bacteria
ICC No 125;
ICC No 133
AACC 42-11
5
Yeast and Mould
ICC No 146
AACC 42-50
6
Peroxide value
AOAC 965.33
7
Total aflatoxin (B1+B2+G1+G2) AOAC 972.26;
AACC 45-16;
ISO 16050
8
Granulation
AACC 66-20
9
Vitamin A
AOAC 992.04
AACC 86-03
10 Iron
AOAC 944.02
AACC 40-41B
11 Zinc
AOAC 999.10
AACC 40-75
12 Coliforms
AOAC 2005.03
13 Escherichia coli
AOAC 991.14
ISO 166493:2005
14 Salmonella
AACC 42-25B
15 Staphylococcus
AACC 42-30B
16 Bacillus cereus
AOAC 980.31
17 GMO
ISO 24276-2006;
ISO 21571-2005
18 Heavy Metals
ISO 11212-1, 2, 3,
4_1997
19 Pesticide Residues
AOAC 970.52
* Or equivalent
** Working days needed for performance of the analysis

Table 3: Laboratory Analysis Price for MAIZE

USD________/ Sample (Average cost for Compulsory and Optional Analysis)
No Analyses/tests

Reference methods*

Rate per
sample
(USD/sample)

Lead Time
required to
submit

P a g e 11 | 19

results
(days)**

1 Organoleptic
2 Moisture
Total blemished
3 (defective) grains
4 Insect damaged
5 Stained
6 Diseased
7 Shrivelled
8 Broken
9 Discoloured
10 Germinated
11 Frost damaged
Other grains, foreign
12 matter and filth (total)
13 Other grains
14 Foreign matter
15 Filth

Organoleptic and ISO 605

AACC 44-15A
ICC method no. 110
ISO 711-2009
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
ISO 5223-1995
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
Visual, Gravimetry
AOAC 972.26;
AACC 45-16;
ISO 16050

16 Aflatoxin
* Or equivalent
** Working days needed for performance of the analysis
Table 4: Laboratory Analysis Charge for PULSES
USD_______/ Sample (Average cost for Compulsory and Optional Analysis)
No

Parameter

Reference method*

1
2
3
4
5
6
7
8

Size
Undersized
Purity
Foreign matter
Moisture
Discoloured
Colour
Live insects at all stages of
development
Mouldy grain
Cooking time

ISO 605-1991
ISO 605-1991
ISO 605-1991
ISO 605-1991
ISO 24557-2009, 712-2009
ISO 605-1991
ISO 605-1991

9
10
11

Rate per
sample
(USD/sample)

Lead Time
required to
submit
results
(days)**

ISO 6639-4_1983
ISO 605-1991

ICC No 125;
Mesophyllic aerobic bacteria AACC 42-11
P a g e 12 | 19

12

ICC No 146
AACC 42-50

Yeast and Moulds

* Or equivalent
** Working days needed for performance of the analysis
Table 5: Laboratory Analysis Charge for SALT
USD_______/ Sample (Average cost for Compulsory and Optional Analysis)

No

Parameter

Reference method*

Sodium chloride (NaCl)

Moisture content

ISO 2483:1973

Iodine

ESPA/CN 109/84

Alkalinity as Na2CO3

Acid insoluble matter

Barium

Arsenic (As)

ECSS/SC 312-1982

Copper (Cu)

ECSS/SC 144-1977

Lead (Pb)

ECSS/SC 313-1982

10

Cadmium (Cd)

ECSS/SC 314-1982

Rate per
sample
(USD/sample)

Lead Time
required to
submit results
(days)**

ISO 2479:1972

11 Mercury (Hg)
ECSS/SC 312-1982
* Or equivalent
** Working days needed for performance of the analysis

P a g e 13 | 19

Table 6: Laboratory Analysis Price for Refined EDIBLE OILS

USD________/ Sample (Average cost for Compulsory and Optional Analysis)
No

Parameter

Reference method*

Water and impurities

Insoluble impurities

Free fatty acid

4
5

Erucic acid
Acid value

Colour

Soap content

Peroxide number

Iodine value

10

Saponification

11

Unsaponifiable matter

12

Refractive index

13

Relative density

ISO 662:1998
AOCS Ca 2d-25
IUPAC 2.601
ISO 663:2007
AOCS Ca 3a-46
IUPAC 2.604
ISO 18395:2005
AOCS Ca 5a-40
AOAC 940.28
UNE 55120:1981
ISO 660:2009
AOCS Cd 3d-63
BS 684-1.14:1998
AOCS Cc 13b-45
AOCS Cc 15-60
AOCS Cc 17-95
ISO 3960:2007
BS 684-2.14:2001
AOCS Cd 8-5,8b-90
AOAC 965.33
IUPAC 2.501
ISO 3961:2009
AOCS Cd 1-25
AOAC 993.20
IUPAC 2.205
ISO 3657:2002
AOCS Cd 3-25
AOAC 20.160
ISO 18609:2000
ISO 3596:2000
AOCS Ca 6a 40
IUPAC 2.401
ISO 6320:2000
AOCS Cc 7-25
AOAC 921.08
IUPAC 2.102
AOCS 10c-95
IUPAC 2.101

14
15
16

Vitamin A
Vitamin D
Delta-7-Stigmasterol (for
soybean oil)
Butylated HydroxyAnisol
Butylated

17
18

Rate per
sample
(USD/sample)

Lead Time
required to
submit results
(days)**

ISO 12228:1999

P a g e 14 | 19

19

HydroxyToluene
Linolenic acid (C18:3)

20

Linoleic acid (C18:2)

ISO 5508:1990
ISO 5509:2000
ISO 5508:1990
ISO 5509:2000

* Or equivalent
** Working days needed for performance of the analysis

P a g e 15 | 19

ANNEX V
Proposals Evaluation Criteria
The evaluation of the proposals will be in two parts: Technical Evaluation and Financial
Evaluation. The Technical Evaluation will be accorded a weight of 60 points and the Financial
Evaluation will be accorded a weight of 40 points.
Details of both technical and financial evaluation criteria are given below:
A. Technical Evaluation Criteria (60 points): Please, fill in the relevant information in the
table below:
Table 7
No
.
1

3
4
5
6
7
8
9

Technical Evaluation Factor

60 Points

Your Proposal

Relevant experience Indicate the

number of years of experience in
food quality & quantity inspection
(minimum of three years experience
required)-10 pts
Number of qualified and
experienced inspectors (minimum of
5 inspectors required) Attach
CVs)-10 pts
Experiences of the Inspectors
(minimum of three years
experiences) Attach CVs.-10 pts
Designation of Account Manager
Qualified and experienced Attach
CV- 10 pts
International Quality Certifications
At least one. Attach copy-5 pts
Having own Laboratory Attach
evidence-5 pts
Average turn-around time for release
of lab test results (from day of
sampling) in calendar days-5 pts
Representation in the SADC
Countries Attach list of countries5 pts
Total
60 points

B. Financial Evaluation Criteria (40 points):

Table 8
No
.
1
2

Financial Evaluation Factor

40 Points

Your Proposal (Prices in USD)

Average price for inspection and

sampling for all commodities (USD
per MT)-5 pts
Price for lab testing of Super Cereals
- Corn Soya Blend Plus USD per
P a g e 16 | 19

3
4
5
6
7
8
14

sample-5 pts
Price for Lab test of Maize MealUSD per sample-5 pts
Price for Lab Test of Maize
USD per sample-5 pts
Price of Lab test for Pulses
USD per sample-5 pts
Price of Lab Test for Salt
USD per sample-5 pts
Price of Lab Test for Vegetable Oil
USD per sample-5 pts
Price for full GMO testing
USD per sample-5 pts
Total

40 points

For subcontracted laboratories, fill out the tables in Annex VI.

P a g e 17 | 19

Annex VI: Subcontracted laboratories details

1. Is/are the laboratory (ies) approved on a written procedure? If yes, please summarize the
procedure and decision criteria. Please provide a copy of the procedure.
Answer:

Document
to be
provided

2. Please provide a list of your subcontracted laboratories

Answer: (Cf. the below table)
3. In case of several subcontracted laboratories, please explain the management of the
analysis between the different laboratories (e.g. by commodity, geographical zone)
Answer: (Cf. the below table)
4. In case of subcontracted laboratory (ies) localized in a different country, please precise
the time required for obtaining the analysis results.
Please precise it for each laboratory localized in a different country.
Answer:
5. In case of subcontracted laboratory (ies) localized in a different country: are the
samples held by Customs? If yes, please define the period of samples keeping and define
any case of forcing sampling hold at the Custom clearance
Please precise it for each laboratory localized in a different country.
Answer:
6. In case of subcontracted laboratory (ies) localized in a different country, please precise
the samples export constraints (e.g. restricted types of commodities can be exported.)
Answer:

P a g e 18 | 19

#
1

Subcontracted Food Laboratory

- Contact details

Explanation

Name:
Phone number:
Address:
City:
Country:
Name:
Phone number:
Address:
City:
Country:
Name:
Phone number:
Address:
City:
Country:
Name:
Phone number:
Address:
City:
Country:
Name:
Phone number:
Address:
City:
Country:
Name:
Phone number:
Address:
City:
Country:

P a g e 19 | 19