PURCHASE REQUISITION FORM

This is NOT a Purchase Order

Requisition Date : 10 June 2020 Date Needed

Requested By : Pujiyono PR No. :

Department : ESRS WO No.:

No. QTY UNIT ITEM DESCRIPTION Attachment Function

(attach second page for additional items)

Untuk Kelengkapan Equipment Fire

1 1 Pcs Stanley 36-inch FatMax Wrecking Bar Brigade/Pemadam Kebakaran

Untuk Kelengkapan Equipment Box

Jet Nozzle Machino 1.5 inch Merk Hydrant di Lt. B5 (1 pcs), Lt. B6 (3
2 4 Pcs
Appron/Hooseki pcs)

FRM/PUR-00-1 01-09-2016 REV.00