Finance Form 3 PAPUA NEW GUINEA Requisition No:

Revised 3/79

REQUISITION FOR EXPENDITURE Job/Movement

Authority No:

To: Provincial Administrator SUPPLIER’S ADDRESS PARTICULARS QUANTITY RATE AMOUNT

(Financial Delegate) Tema Auto Parts ltd P.o.box K5,000.00

60, Kundiawa Simbu
Province
From: Transport management unit
Refer to attachment ff4
Department of: Simbu Provincial Administration
Subject to availability of funds, purchase of the

undermentioned goods/services is approved for delivery

To: Tema Auto Parts Ltd Holdings
Reasons: Being payment for obtaining spear parts to
service/maintain Govt vehicle Reg: PAI- 122 (provincial works)

DIV FN ACT ITEM AMOUNT

This Year
Financial
280 10486-00 225 225 -1 K5,000.00
Subsequent t Financial Years
Cash Fund Cert No of
Financial Delegate TOTAL K5,000.00
1. 2 Funds are available COMMITMENT DETAILS
(Authorised Requisitioning Officer) Goods or services Est Cost Com’t No. ILPO
C No:
(Financial Delegate/Commitment Clerk Travel Fare
(Designation) (Date) Excess Baggage to
3. Approval of Section 24 Officer (Designation) (Date) Accommodation
(Required for all requisitions over K500) 4. Funds have been committed Goods and Services

Approved Not Approved NOTE: 1. Travel and accommodation:

(Commitment Clerk) Approved Itinerary is required (See Over)

(Section 24 Officer) (Designation) 2. Goods and Services:

K / / (Date) Written quotations are required if costs exceeds K500.
(Designated Limit) ( Date)

TRAVEL ITINERARY

NAME FROM TO ETD DATE ETA DATE ACCOMMODATION

Approved Not Approved (Officer In Charge) (Designation) Date