NEPAL WATER FOR HEALTH, HEADQUARTER, KATHMANDU FORMAT FOR PROPOSAL SUBMISSION “Study on Sustainability of Hygiene Behavior” AusAID supported WASH Projects 1. Details of Organization Name of firms / Individual freelance consultancy: Address: Phone No: Fax No: Email: Category of firm: Area of specialization 1. Individual freelance consultancy 2. NGO 3. Consultancy firm 1. Water, Sanitation and Hygiene 2. Health 3. Others (Specify) Registration incase of consultancy firm/NGO Registered to: 1. 2. Registration no: PAN/VAT# Last audit date: 2. Principal Investigator: Name: Academic qualification: Contact no. Pan no (for individual Submission) Post Held Field of Specialization in Health & WASH Total number of years of working in the field of specialization: (Health & WASH) 3. Title of Proposed Study any other: (maximum 100 characters) 4. Budget breakdown of the program: 1. Lead facilitator cost 2. Enumerators cost 3. Travel cost 4. Stationary/printing/typing/computer processing cost 5. Orientation cost 6. Contingency cost 7. Others cost (specify) 8. Total cost Note: Attach the detail budget in annex 5. Duration of the study: 6. Study Objectives & output: a) Objectives: (Maximum 200 characters) b) Deliverables/output in specific terms including intermediate output: (Maximum 200 characters) 7. Outline & methodology of the study: (maximum 150 words) 8. Data Collection and Analysis: (150 words) 9) Utility of 6 (a) & (b) in the WASH sector: (50 words) 10) Annex: Attach the following documents: 1. ORGANIZATION’S CONSTITUTION PAPER 2. LEGAL DOCUMENT OF ORGANIZATION REGISTRATION, AUDIT REPORTS AND TAX CLEARANCE CERTIFICATE 3. PAN CERTIFICATE FOR INDIVIDUAL CONSULTANT 4. RESUME OF PRINCIPLE INVESTIGATOR 5. DETAIL BUDGET BREAKDOWN 6. DETAIL PLAN OF ACTION 7. AT LEAST THREE STUDY REPORT RELATED TO HEALTH / WASH RSEARCH METHODOLOGY AND ANALYSIS.