SERVICE RECEIVED NOTE (SRN)

Date: 7-Jul-21 SRN #:

MM/NUM/LOC/YEAR SRN-07-001-TIP-2021

Receving office: Tripoli-main office Page # (x of y):

1OF1

Received from: (Service Purchase Order / Contract

provider, Donor)
Ala Amhimmid Alyousufi Work Order ref #

Project / Grant: KOA Donation letter:

No. Service Description Unit of measure

Control Result
(Distance, m2, repair, Justification if rejected (list issues). Use additonal pages if required
(Passed/ Rejected)
Lumpsum)

1 Maintenance of 10 air conditioners Service Passed 0

END

Notes:

QUALITY CONTROL (Technical) if different form service recipient

DELIVERED BY (Supplier representative) SERVICE CONFIRMED AS RECEIVED BY:
(Starting $1,000)

Name: Ala Amhimmid Alyousufi Name: Osama Abdulgani Name: Ahmed Almoudi

Position: Position: Position: warehouse manager

Date: Date: Date:

7/7/2021

Signature: Signature: Signature: