Name of NGO
Purchase Requisition Form
Project/Department : Project department name PR No. : 121/SS/LOG/ER-SUL/19
Requested by : Name of Logistician Date : 12 Desember 2018
For Delivery to : Name of place to deliver Charge to Name of Instantion
Expected Delivery Date : Priority, latest 10 (ten) days from the date here of
Item(s) Description Specifications Quantity Price Budget Availability
Camera Canon EOS 750D 1 7,039,700 7,039,700
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TOTAL 7,039,700
Request By : Date:
Project Manager Approval : Date: