AMIGOS MATERIAL / SERVICES REQUISITION FORM

Dong Xuyen Industrial Park

Ward 10, Vung Tau City, SR Vietnam
x MDB RUSH CRITICAL ORDINARY

PROJ. NO.: Dong Xuyen Facility COST CENTRE NAME: QC Department

MRF#: 8002 COST CODE NO: DEP-SSFQ

DATE: 5-Mar-07 DATE REQUIRED: 05-Mar-07

SI. Description
Item Unit of Actual To be Supplier P.O. /
Control Code Material Description, Size, Specs, Remarks In Stock
Code Measure Required Procured Code S.O. No.
No.
1 Ink for HP Laserjet (Q2624A) box 1 - 1

Supplier Final Evaluation Supplier Final Evaluation

Requisition Requirement Stock Request Requisition Requisition
Checked by Endorsed Requisition
Prepared / Requested Checked by Approved by Received by Approved by Received by
by Proj. Closed
by Proj. Services Store Management Procurement Management Purchasing
Services

D.N.Tuan

COPY DISTRIBUTION: (1) ORIGINAL : Procurement (2) COPY 1 : Originator (3) COPY 2 : Purchasing (4) COPY 3: Store
NOTE: Once the Requisition is closed, ORIGINAL will be forwarded by Procurement to Purchasing. Form No.: MSR.01 Rev.2 - 01.08.05
 AMIGOS MATERIAL / SERVICES REQUISITION FORM
Dong Xuyen Industrial Park
Ward 10, Vung Tau City, SR Vietnam
MDB RUSH CRITICAL ORDINARY

PROJ. NO.: COST CENTRE NAME:

MRF#: COST CODE NO:

DATE: DATE REQUIRED:

SI. Description
Item Unit of Actual To be Supplier P.O. /
Control Code In Stock
Code Material Description, Size, Specs, Remarks Measure Required Procured Code S.O. No.
No.

Stock Supplier Final Evaluation Supplier Final Evaluation

Requisition Requirement Request Requisition Requisition
Checked by Requisition
Prepared / Requested Checked by Approved by Received by Received by
Endorsed by Approved by Closed
by Proj. Services Store Management Procurement Proj. Services Management Purchasing

COPY DISTRIBUTION: (1) ORIGINAL : Procurement (2) COPY 1 : Originator (3) COPY 2 : Purchasing (4) COPY 3: Store
NOTE: Once the Requisition is closed, ORIGINAL will be forwarded by Procurement to Purchasing. Form No.: MSR.01 Rev.2 - 01.08.05