Request for LPG Gas UNICEF Staff Association

Name of the requester: Tanuj Ghimire

Designation: Info Mgmt Officer- NO B
Agency: UNICEF
Duty Station: Kathmandu
No. of Family members:

Contract Status:

Contract Type: FT/TA 1 year/ TA 6 month/consultant

(size) 4 Persons

International .

National .TA-1 Yr

Contact No.: 9841634431

Office Extension:
Cell No. 9841634431
Date of Request: 12/28/2015
Personal Details on family:
S.N.

Pregnant
woman

Below 2
yrs

Below 6
yrs

Below 12
yrs

NA

NA

NA

NA

Below 18
yrs
(appearing
for SLC or
Board)
NA

Elders
parents
(above 65
years)
2

Is STC
Will buy
cylinder
new
available? cylinder.

NO

YES

2
Note: Please indicate numbers in the coloumn.
STC: Salt Trading Corporation Limited.
* Please clarify urgent need details.
Conditions apply:
1. Comply with Staff Association rules;
2. Distribution will be based on priority given by staff association
3. Staff has to be on queue as per given date and time, will be on the last if missed.

Signature of Requestor.

Approved by Staff Association

Urgent
Need?*

YES