321x Filetype XLSX File size 0.03 MB Source: www.humanitarianresponse.info
Sheet 1: Form 1
| Distribution of nutrition items under PCA | ||||||||||||||||
| Name of Partner: | Form 1 | |||||||||||||||
| PCA No: | ||||||||||||||||
| Date of start of PCA: | ||||||||||||||||
| Date of Expiry: | ||||||||||||||||
| Warehouse from where the items would be drawn: | ||||||||||||||||
| Item | Code | Pack | Qty under PCA | Jan-14 | Feb-14 | Mar-14 | Apr-14 | May-14 | Jun-14 | Jul-14 | Aug-14 | Sep-14 | Oct-14 | Nov-14 | Dec-14 | TOTAL |
| Plumpynut sache CAR/ 92 g-150 | S0000240 | CAR | 0 | |||||||||||||
| Amoxillin pdr oral sus 125 mg bot 100 ml | S1505046 | BOT | 0 | |||||||||||||
| Amox 250mg tab Pac 10 | S1505045 | PAC | 0 | |||||||||||||
| Amox 250mg tb Pac20 | S1505044 | PAC | 0 | |||||||||||||
| Weighing trousers pac | S0189000 | PAC | 0 | |||||||||||||
| Micronutrients film tab Pac 1000 | S1580100 | PAC | 0 | |||||||||||||
| Albendazole 400 mg chew pac 1000 | S1555370 | PAC | 0 | |||||||||||||
| Scale inf. Spring | S0557000 | EACH | 0 | |||||||||||||
| ReSoMal 42 g Sach Car 100 | S1561125 | CAR | 0 | |||||||||||||
| F-100 ther diet sach 1114 g Car 90 | S0000209 | CAR | 0 | |||||||||||||
| F-75 ther diet sach 102 g Car 120 | S0000208 | CAR | 0 | |||||||||||||
| Portable bay/child L-H Meas | S0114540 | SET | 0 | |||||||||||||
| Weighing scale el moth child 150 kg x 25 g | S0141021 | EA | 0 | |||||||||||||
| Mebendazole 500 mg chew tab pack 100 | S1555360 | PAC | 0 | |||||||||||||
| MUAC child 11.5 red PAC-50 | S0145620 | PAC | 0 | |||||||||||||
| MUAC Adult | S0145630 | PAC | 0 | |||||||||||||
| Retinol 100 K IU soft gel PAC caps. PAC-500 | S7800001 | PAC | 0 | |||||||||||||
| Retinol 200 K IU soft gel PAC caps. PAC-500 | S7800002 | PAC | 0 | |||||||||||||
| Portable bay chd L-H meas./SET-2 | S0114530 | SET | 0 | |||||||||||||
| Scale infant spring type 25 kg x100g | S0145555 | EA | 0 | |||||||||||||
| Fe +folic acid 60+0.4 mg tab/PAC 1000 | S1550025 | PAC | 0 | |||||||||||||
| Multiple Micro. Nut pdr | S1580201 | PAC | 0 | |||||||||||||
| Port. Baby chd L-H | S01145200 | SET | 0 | |||||||||||||
| Form 2 | |||||||||||
| UNICEF, Juba South Sudan | |||||||||||
| Request for Supply | |||||||||||
| Name of Partner: Date: | |||||||||||
| PCA No: Expiry Date: | |||||||||||
| PCA Amendment date Expiry: UNICEF Warehouse: | |||||||||||
| Quarter ending: 2014 Location of Supply | |||||||||||
| Sr No | Item | Unit | Total units in PCA | Total units collectedtill date | Units utilised till date | Balance stock | Expiry date | No. of units requested | Date up to which will be utilised | Remarks | |
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| 0 | |||||||||||
| Name and Title of Partner (Designated Focal Official) | |||||||||||
| Signatures: | |||||||||||
| Recommendation/Remarks of UNICEF Nutrition Specialist. | |||||||||||
| To be submitted min. two weeks in advance of expected delivery of items. | |||||||||||
| To be submitted as pdf and signed by the focal official and stamp | |||||||||||
| Monthly Stock Report of Partners Form 3 | ||||||||
| Name of Partner: | ||||||||
| PCA No: | ||||||||
| Month | ||||||||
| Item | Code | Pack | Opening stock | Stock Rceived during the month | Stock used during the monthh | Balance at the end of month | Location of balance stock | Remarks |
| Plumpynut sache CAR/ 92 g-150 | S0000240 | CAR | 0 | |||||
| Amoxillin pdr oral sus 125 mg bot 100 ml | S1505046 | BOT | 0 | |||||
| Amox 250mg tab Pac 10 | S1505045 | PAC | 0 | |||||
| Amox 250mg tb Pac20 | S1505044 | PAC | 0 | |||||
| Weighing trousers pac | S0189000 | PAC | 0 | |||||
| Micronutrients film tab Pac 1000 | S1580100 | PAC | 0 | |||||
| Albendazole 400 mg chew pac 1000 | S1555370 | PAC | 0 | |||||
| Scale inf. Spring | S0557000 | EACH | 0 | |||||
| ReSoMal 42 g Sach Car 100 | S1561125 | CAR | 0 | |||||
| F-100 ther diet sach 1114 g Car 90 | S0000209 | CAR | 0 | |||||
| F-75 ther diet sach 102 g Car 120 | S0000208 | CAR | 0 | |||||
| Portable bay/child L-H Meas | S0114540 | SET | 0 | |||||
| Weighing scale el moth child 150 kg x 25 g | S0141021 | EA | 0 | |||||
| Mebendazole 500 mg chew tab pack 100 | S1555360 | PAC | 0 | |||||
| MUAC child 11.5 red PAC-50 | S0145620 | PAC | 0 | |||||
| MUAC Adult | S0145630 | PAC | 0 | |||||
| Retinol 100 K IU soft gel PAC caps. PAC-500 | S7800001 | PAC | 0 | |||||
| Retinol 200 K IU soft gel PAC caps. PAC-500 | S7800002 | PAC | 0 | |||||
| Portable bay chd L-H meas./SET-2 | S0114530 | SET | 0 | |||||
| Scale infant spring type 25 kg x100g | S0145555 | EA | 0 | |||||
| Fe +folic acid 60+0.4 mg tab/PAC 1000 | S1550025 | PAC | 0 | |||||
| Multiple Micro. Nut pdr | S1580201 | PAC | 0 | |||||
| Port. Baby chd L-H | S01145200 | SET | 0 | |||||
| To be submiited by 10 th of every month for the preceding month | ||||||||
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