Philips - Mobile X-ray - MobileDiagnost wDR R2

WB Project #*

Lead agency*

Country*

Your Name*

Title*

Email*

Phone*

Are you the authorized signatory?*

Yes

No

Authorized signatory: Name*

Authorized signatory: Title*

Authorized signatory: Email*

Authorized signatory: Phone*

PIU: (name)*

Name*

Email*

Title*

TTL:*

Delivery city and airport*

Language for Training Materials

OPTION 1: Use the Government’s / purchasing agency’s eSignature platform

Yes

No

OPTION 2: Use the supplier’s eSignature platform

Yes

No

OPTION 3: Use the supplier’s eSignature platform to download the contract, sign the hard copy, then scan and upload into

Yes

No

OPTION 4: Sign in counterparts, with email exchange of soft copies and/or a courier exchange of hard copies

Yes

No

OPTION 5: Sign in country

Yes

No

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