ࡱ> |~yz{ ?bjbjWW 55 6 6 $PCL,,BBBF"F"F"$AF"" "@F"F"BB˝<(((F"BB(F"((~$LBИ.$6X|<CHǣ6%ǣLǣL0F"F"(F"F"F"F"F"'F"F"F"CF"F"F"F"ǣF"F"F"F"F"F"F"F"F"6 V:  Expression of Interest Individual Consultants Project Data Project Name Assignment  Consultant Data NameCountry of NationalityAddress of consultant E-mail of consultant Assignment Specific Qualifications and Experience Assignment Specific Experience (Provide information demonstrating your ability, skills and experience to undertake advertised assignment and deliver inputs/ outputs required under the TOR) Please provide summary of your qualifications and attach your Curriculum Vitae (CV)   Eligibility Declaration I, the undersigned, certify to the best of my knowledge and belief The CV I attached correctly describes my qualifications and my experience I am not part of the team who wrote the terms of reference for this consulting services assignment. I am not sanctioned (not eligible for engagement) by ADB or another MDB. I have not been convicted of an offense or crime related to theft, corruption or fraud. I understand that it is my obligation to notify ADB should I become ineligible to work with ADB or another MDB, or should I be convicted of an offense related to theft, corruption or fraud. I understand that any misrepresentations that knowingly or recklessly mislead, or attempt to mislead may lead to the automatic rejection of the proposal or cancellation of the contract, if awarded, and may result in further remedial action, in accordance with ADBs Anticorruption Policy. Completed by (Name/Position)  Date (dd/mm/yyyy) Attachment: Curriculum Vitae Curriculum Vitae (CV) 1. Name of Expert [Insert full name]: 2. Current Residential Address: ______________________________________________ Telephone No.: ________________________________________________ Fax No.: ________________________________________________________________ E-Mail Address: _________________________________________________________ 3. Date of Birth: Citizenship: 4. Education [Indicate college/university and other specialized education of expert, giving names of institutions, degrees obtained, and dates of obtainment]: 5. Membership in Professional Associations: 6. Other Trainings [Indicate significant training since degrees under 5 - Education were obtained]: 7. Countries of Work Experience: [List countries where expert has worked in the last ten years]: 8. Languages [For each language indicate proficiency: good, fair, or poor in speaking, reading, and writing]: 9. Employment Record [Starting with present position, list in reverse order every employment held by expert since graduation, giving for each employment (see format here below): dates of employment, name of employing organization, positions held.]: From [Year]: To [Year]: Employer: Positions held: 10. Detailed Tasks Assigned [List all tasks to be performed under this assignment]13. Work Undertaken that Best Illustrates Capability to Handle the Tasks Assigned [Among the assignments in which the expert has been involved, indicate the following information for those assignments that best illustrate the experts capability to handle the tasks listed in line 11.] Name of assignment or project: Year: Location: Client: Main project features: Positions held: Activities performed:  11. Certification: I, the undersigned, certify to the best of my knowledge and belief: Yes No (i) this CV correctly describes my qualifications and my experience (ii) I am a close relative of a current ADB staff member (iii) I am the spouse of a current ADB staff member (iv) I am a former ADB staff member.  If yes, I retired from ADB over 12 months ago  (v) I am an employee/consultant of a Client Party (v) I am part of the team who wrote the terms of reference for this consulting services assignment.  (vi) I am sanctioned (not eligible for engagement) by ADB. I understand that any willful misstatement described herein may lead to my disqualification or dismissal, if engaged. 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