MATERIAL/SERVICE PURCHASE REQUISITION FORM

PROCUREMENT ONLY
Requisition Number: ______________

Date: 31/05/2011 Project No: ____

Department: IT Cost Center: 603 _ _ _ _ _ _ _ _ _
Contract No: _ _ _ _ _ _ _ _ (if applicable)

ITEM / DESCRIPTION Unit Price Quantity TOTAL SUGGESTED SUPPLIERS

(Please give detailed specifications*) (Rs)

20,325 1 20,325
MAURITIUS TELECOM/
ORANGE

20,325 20,325
TOTAL ORDER

TOTAL ORDER VALUE (INC 15% VAT) 23,373.75 23,373.75

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

Justifications: 1-CARD SYSTEM; this system requires a private APN network to be configured for it to run. The above router is critical and required for the APN configuration.
Delivery address: QUAY D ROAD - 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 – 31/05/2011

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

Received by procurement on:

Received by procurement on: