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APPENDIX XVII: STUDENTS’ REQUISITION FORM - SAMPLE FORM 03

Student's Name Suhana Bt Ramli Student's ID 12345
E-mail Address Suhana_ramli@utp.edu.my Contact No 012-345 6789
ETP Group No 91 Date 14 Feb 2008
Project Title Electron X – provide brief description

Note: The cost of preparing project reports and posters including photocopying and stationeries are to be
borne by the students themselves.

Dimension (L X W X H)/ Unit
Vendor / Amount
No. Item Brand & Model description / material / Price Qty
supplier (RM)
specification (RM)
1 Photovoltaic module Kyocera 120 X 10 X 10 mm / 250W Sunny Boy 88.90 1 88.90
2 Inductor Sumida CDH53 68 uH 1.5Arms 0.18DCR Xcel Circuit 63.50 1 63.50
3 Padding N/A 50 X 11 X 6 mm / rubber Eng Huat 5.00 6 30.00
4 Dividers N/A 3" X 6" sheet metal / steel Eng Huat 8.50 3 25.50
5 Spray paint Net Paint 1 liter / Oil-based paint Eng Huat 10.00 2 20.00
6 Galvanised washers N/A 3/8" / steel Eng Huat 3.50 4 14.00
7 Ply wood N/A 100 X 80 X 6 mm / wood Eng Huat 12.80 1 12.80
8 Hinges N/A 30 X 90 mm / brass Eng Huat 2.00 2 4.00

Total 258.70

Verified by: Certified by: Endorsed by: Approved by:
(Lab Executive) (Project Supervisor) (ETP Coordinator) (Programme Head)
Signature

Official
Stamp

Date