PURCHASE REQUISITION FORM (PR)

REQUESTER INFORMATION: NOTE: Signed Hard And Soft Copy To Be Emailed To: KamoaStore@Ivanplats.com - For Stock And Non-stock Items Only
*Date of the PR: 2-Oct-20 For Any Special Instructions Regarding This PR: RFQ Closing Date: 5-Oct-20
RFQ Number:
*Department: Oprrational Engineering
(Procurement To Complete)
*Contact Name: Corne De Lange *Operations Order: Yes / No

*Telephone: +243 826 393 626 *Project Order: Yes / No

*e-mail: CorneDL@Kamoacopper.com *Capital Order: Yes / No

COMPANY ADDRESS: PRIORITY CLASSIFICATION

Breakdown order *Emergency Breakdown
2153, Avenue Club Nautique, Quartier Golf Les Battants
Critical Process 0
Commune de Lubumbashi, Ville de Lubumbashi *Urgent Process 1
Province du Haut-Katanga, République Démocratique du Congo *Normal Process 2
***If The Above Options Are Not Selected, Operation
Vat No. A0901048A
Order & Normal Process Will Be Selected By Default.
Reg No. 1998/000334/07 *Required By: (DATE)

*UNIT OF *PART
ITEM JDE ITEM NUMBER *QUANTITY QTY ON HAND *ITEM DESCRIPTION / SPECIFICATIONS *BRAND / MAKE UNIT PRICE TOTAL PRICE
MEASUREMENT NUMBER(S)
1 OX 20 ea 200 mm (8 inch) Butterfly valves 0

2 OX 20 ea 200 mm (8 inch) Dubbel waffer non return valves 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

10 0

11 0

12 0

13 0

14 0

15 0
Total 0
*BUDGET HOLDER SIGNATURE : *NAME: Carl Herselman *DATE: 12/6/2020
Total Amount 0
*COST CODE: *IN BUDGET: YES / NO
(MANDATORY FIELD) 101300001.100120. *WBS CODE: 22818 (MANDATORY FIELD)