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In-Kind Contribution Form Please submit a separate form for each implementing agency
1. Name of Donor:*
2. Implementing Partner:*
Contribution against 2005 Appeal Contribution for general emergency activities
3. Sector : Please tick applicable sector(s) and, if available, provide allocated item and quantity in the first box (Item and Quantity) and indicate relevant regions in the second box (Code) by using the equivalent regional codes stated here below.
Afar=1 Amhara=2 Beneshangul Gumuz=3 Dire Dawa=4 Gambella=5 Harari=6 Oromiya=7 SNNPR=8 Somali=9 Federal/Country Wide=10
Item and Quantity Code (1, 2, 3, ...) Agriculture Livestock Coordination Education Health and Nutrition Protection Water and Sanitation Shelter and Household Items Disaster Management and
Capacity Building Post Emergency Recovery
and Rehabilitation Logistics and Operational Support
Other relief sector
* Required Information
To ensure accurate and timely reporting on humanitarian contributions, we will be contacting you for contribution updates on a quarterly basis.