P.O Box 37098 Slochterweg 35 Phone: +31 20 4033051 e-mail: info@idafoundation.

org
1030 AB Amsterdam 1027 AA Amsterdam Fax: +31 20 4031854 www.idafoundation.org
The Netherlands The Netherlands

Customs Invoice
IDA Customer No:108127 Destination of the Goods Delivery Number: 47782
Federal Ministry of Health Ethiopian Pharmaceutical Supply Agency Date: 21/07/2023
Sudan St. Addis Ketema Subcity, Kebele: 05
ADDIS ABABA In front of St Paulos Hospital
Ethiopia Swaziland Street
P.O. Box 21904
ADDIS ABABA
Ethiopia

Order Number: 23210531 SO IDA Reference: 23210244 SQ

Shipment Number: 1286502 Your Reference: ETH/DP/23/13521

IDA Code Description Quantity Lot Number/Expiry Date Unit Price Amount Manufacturer Origin
1921-BL1-TB-MIC-39B Ethambutol HCl 100mg dispersible, 779 EDBH023B 21,910 17.067,89 Micro Labs Hosur India
100 tab bl 31/05/2027

1921-BL1-TB-MIC-39B Ethambutol HCl 100mg dispersible, 2.990 EDBH024A 21,910 65.510,90 Micro Labs Hosur India
100 tab bl 31/05/2027

1932-BL1-TB-MIC-39B Isoniazid 100mg 100 tab bl 2.278 IZBH097/1 1,270 2.893,06 Micro Labs Hosur India
31/05/2027

Total of goods 85.471,85

Procurement Fee 3.376,06
Insurance 112,79
Quality Analysing Charges 42,83
FREIGHT 5.432,38
PRE SHIPM INSP CHARGES 300,00

Page 1 of 2
IDA Foundation ABN Amro Bank: 024.32.60.342 IBAN: NL28ABNA0243260342
SWIFT: ABNANL2A VAT Reg. Nr: NL 002956184B01
Reg. nr. Chamber of Commerce Amsterdam 33170905. All transactions with IDA Foundation are subject to our general terms and conditions as deposited at the Chamber of Commerce Amsterdam
P.O Box 37098 Slochterweg 35 Phone: +31 20 4033051 e-mail: info@idafoundation.org
1030 AB Amsterdam 1027 AA Amsterdam Fax: +31 20 4031854 www.idafoundation.org
The Netherlands The Netherlands

Delivery Number: 47782

Total Carriage and insurance paid to, Transport USD

by air, ADDIS ABABA 94.735,91

Payment terms: Prepayment

Your sales support: Anna Pellicer

Page 2 of 2
IDA Foundation ABN Amro Bank: 024.32.60.342 IBAN: NL28ABNA0243260342
SWIFT: ABNANL2A VAT Reg. Nr: NL 002956184B01
Reg. nr. Chamber of Commerce Amsterdam 33170905. All transactions with IDA Foundation are subject to our general terms and conditions as deposited at the Chamber of Commerce Amsterdam