Questionnaire

If yellow or shaded, delete all entries but one per entry Please use Times New Roman 11 point

Category of Consultant’s Business: / Firm ≥5 specialist staff
Firm < 5 specialist staff
Individual Consultant / Sector, sub-sector and discipline specialization / 1  Energy
2  Environmental Assessment
3  Financial Sub-sectors for expertise in assessing market and regional trends, and regulatory environment:
3.1 Banking industry
3.2 Capital Markets
4  Legal services
5  Manufacturing
6  Management - including, separately,
6.1  archives,
6.2  financial controls,
6.3  general management and organizational development,
6.4  human resources,
6.5  management information systems,
6.6  public relations and
6.7  staff training
7  Procurement
8  Small/Medium Enterprises
9  Telecommunications
10  Transport exc. ports & shipping
11  Ports
12  Shipping
Name of Consultant:
Address of Consultant:
Telephone #: /
Fax:
/ /
Email
/
Name of Contact: /
Tel:
/ /
Email
/
Deputy: / Tel: /
Email
/
Identify Associated Consulting Firms:
Keywords identifying sub - sector experience and types of assignments offered (e.g. pipelines, refineries etc,)
Keywords identifying assignments offered (e.g.assessments, feas-ibility studies, design, etc.)
Experience in
/ Albania / Yes/No* / Georgia / Yes/No* / Russia / Yes/No*
BSTDB
/ Armenia, / Yes/No* / Greece / Yes/No* / Turkey / Yes/No*
Member
/ Azerbaijan / Yes/No* / Moldova / Yes/No* / Ukraine / Yes/No*
States:
/ Bulgaria / Yes/No* / Romania / Yes/No*
Other states in
/ / /
Central and
/ / /
Eastern Europe
/ / /
Experience with
/ ADB / Yes/No* / EU Phare/Tacis / Yes/No* / others
International
/ AfDB / Yes/No* / IBRD/IDA / Yes/No*
Financial
/ EBRD / Yes/No* / IDB (IADB) / Yes/No*
Institutions:
/ EIB / Yes/No* / IFC / Yes/No*

Numbers of in-house specialists in this sector/

discipline:

/ Specify by discipline

* Delete one or other Sheet 1 of 5 sheets maximum

Summary of relevant skill areas and experience (not to overflow this page c. 550 words).

End of Sheet 2 of 5 sheets maximum


Relevant Assignments

Dates /

Assignment title and brief description

/ Name of Client/
Contact name and Tel #/

End of Sheet 3 of 5 sheets maximum