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PROCUREMENT REQUISITION FORM

(for goods and services)

Scrubs B16:L23

Agency/Project:
Location:

Requisition No:08/0038/Bissau/2015
Bissau

Date PR Initiated:

Page Number:

31-Aug

e Delivery Required:

If Specialized Items, suggest Suppli


* Attach samples and/or detailed specification where a

* Use as many lines as needed to descr

* Make separate requisition for different categories of

* Use multiple pages where required.

No.

QTY

UNIT

Grant Budget Line


Allocation

Item Description
Office Chetchen

10

Plastic Chair

Plastic Table

51-70-600

Microwave

51-70-600

Freege

51-70-600

Boiling Ketle

51-70-600

12

Coffe Cups

51-70-600

12

plate Tray

51-70-600

Big Cups

51-70-600

Additional Comments:

Requested by:

(name)

/s/

Program Director

Finance Director

Country Director

Procurement
Officer

Date approved

Date approved

Date approved

Date approved

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