Application New Stock Item (ANSI)

Part A: Requested Item

Description: Chiller Chemical Kurita Kurilex L-111 - Microbicide

OEM Part #: Kurilex L-111 OEM UoM BOTTLE

OEM Name: Goshu Kohsan Substitute Allowed: Yes

Spare Class: Operating Spare Consumable Insurance

Spare Type: Rotable Tools

✔ Chemical (MSDS must be supplied)

Plant Ref: Chiller Water Treatment Chemical - Scale Inhibitor

Criticality High Inspection Required on Receipt

Owner: Processing

Rec. Vendor: Goshu Kohsan Vietnam

Vendor Part #: Kurilex L-111 Vendor UoM: EACH

Cost /UoM: 3,090,000 Currency: VND

Sole Source: No Previous Purchase Order:

Documents: Warranty ✔ Quality Assurance

Expected Less than 12 months Greater than 12 months

Usage

Rec. ROP: Max:

Justification Chiller Water Treatment Chemical for trial MoC 4824 "Chemical injection system
at APT Chiller"

Requested by: Thao Nguyen Phuong E-mail: thao.nguyen4@mht.masangroup.com

Signature: Date: 12/04/2024

Part B: Inventory

Request Approved

Rejected Reason Duplicate

Other

Name: Signature:

Part C: Purchasing Confirmation

OEM Part #: (If different from Part A)

OEM Code: (If different from Part A)

Vendor Part #: (If different from Part A)

Vendor Code: UoM:

Pack Qty: Lead Time (Days)

Name: Signature:

Part D: Material Master (Inventory to complete)

Material Group: Valuation Class:

Spare Class: Spare Type:

ROP: Max: Rounding Value:

MRP Controller: MRP Type: Lot Size:

Name: Signature:

MM Supervisor: Signature:

Part E: Approvals

Manager: Signature:

Max SOH value 25k-50k USD

Director/GM: Signature:

Max SOH value 50k-500k USD

CEO/GD: Signature: