MATERIAL/SERVICE PURCHASE REQUISITION FORM

PROCUREMENT ONLY

Requisition Number: ______________

Date: 17.02.2010 Project No: ____
Department: IT Cost Center: 603 _ _ _ _ _ _ _ _ _
Contract No: _ _ _ _ _ _ _ _ (if applicable)
ITEM / DESCRIPTION SUGGESTED
(Please give detailed specifications*) SUPPLIERS

KLV40EX400 SONY BRAVIA LCD 40” FULL HD @ promo RS 28,200

DVPSR510 SONY DVD PLAYER @ RS 1500 HAPPY
WORLD
CENTRE LTD

TOTAL ORDER VALUE (INV 15% VAT) Rs 34,155

* Scope of work, data sheets, engineering drawings, sketches and project schedules, etc can be submitted as attachment.

Justifications: Office use

Delivery address: CHEVRON HOUSE PORT LOUIS

 Please fill out the following information in case of Project:

Approved ER amount:

(Less) Commitments against ER: _____________

(Less) This PR amount: ________
Remaining balance in ER: _________

Requested/Approved Title Signature Date

Requested by: JDevi Rungasawmi – 17.02.2010

IT Coordinator
Approved by: Department Head
Approved by: Finance Manager

Received by procurement on: