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PURCHASE REQUEST

(for internal use only)


MI/PROC/FM-004/05

Departement/Division* : PROJECT & ENGINEERING Request Category * Budget* : Budget Approved by Financial Controller
PR Date* : 28 Nopember 2017 Good / Material Services Non Budget Budget
No. PR* : 245/MBJ/CON/11/2017

Delivery Address : Pak Richard / Pak Erwin Attachment* : Budget Allocation*


Proyek Reservoir KSB TOR DED EE CAPEX OPEX OVERHEAD Sign & Date: Name

Item # Description (please give information such as scope of work resume and justification, Point of Contact, Special Instruction) Budget Code Quantity Estimated Unit Price Estimated Total Price Delivery Date

1 Pekerjaan Tanah & Pagar Reservoir KSB


Total Pekerjaan 1 Ls Rp 1,097,474,189 Rp 1,097,474,189

Note: - Harga belum termasuk PPN


- Detail Material & Upah pada RAB Terlampir

TOTAL Rp 1,097,474,189
Requested By : Approved by Head Manager Approved by Project Head (for Project) Approved by IT Head (For IT) Approved by O&M (for Maintenance&REHAB) Approved by Tech.Auditor (for REHAB)

Sign & Date: Sign & Date: Sign & Date: Benny Nugroho Sign & Date: Rudhy Erawan Sign & Date: Ook Juwana Sign & Date: Wilmart Siburian

Filled by Procurement Department

Purchase Method Public Bidding Limited Bidding Direct Purchase Direct Reference Purchase NOTE :

Evaluation Method Based on Price Comparison Based on Price & Technical Comparison
Received by Procurement Request Approved by COO Approved by Procurement Head

Sign & Date: Name Sign & Date: Joedi Herijanto Sign & Date: Cecilia Aryani

* Wajib diisi

385235148.xlsx

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