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Proactive Disclosure
Claim for Exchange Rate Adjustments
Disclaimer: The HTML version of these forms is a representation of the content only. Please download the PDF version to use with your procurement. If you encounter problems or have questions regarding the PDF please contact Acquisitions.
Contractor Name:
PWGSC File No.:
Contract No.:
Item/Invoice No.:
Basis of payment for this exchange rate adjustment is detailed in Article ________ of the above-referenced contract.
Foreign Currency Component (FCC) and Exchange Rates used at time of Bid Solicitation and/or Contract Negotiation
Date:
| Item | Unit FCC in Foreign Funds | Quantity | Conversion Factor (initial) | FCC in Canadian Funds |
|---|---|---|---|---|
| (1) | (2) | (3) | (1 x 2 x 3) = (4) | |
Calculation for Exchange Rate Adjustments
Date:
| Item | Unit FCC in Foreign Funds | Quantity | Conversion Factor (claimed) | Total Amount Claimed - in Canadian Funds |
|---|---|---|---|---|
| (5) | (6) | (7) | (5 x 6 x 7) = (8) | |
Exchange Rate Adjustment Amount = (8) - (4)
