PT GULA PUTIH MATARAM No.

: AD G 17 00045
MEDICAL CLINIC Divisi : Medical Sugar Group
Date Needed :
No. PR/WO :
REQUEST FOR PR

STOCK ON HAND (SOH)

Outstandi Usage Last 5 Years Average of
Stock Code 26 Agustus 2017
QTY (R ) ng Usage last 5 New Stock
& Delivery(1) GPM years
No. Description Unit SIL ILP ws Total 2012 2013 2014 2015 2016
Equivalent(
3)

A B C D E F G = C+D+E+F H I J K L M N =A+B+G

1 Kertas size F4 Rim 10 0 0 0 0 0 0

2 Kertas size A4 Rim 10 0 0 0 0 0 0
3 Kertas size Letter Rim 3 0 0 0 0 0 0
4 Kertas size A3 Rim 2 0 0 0 0 0 0
5 Map Folio Forte Warna Hijau Pcs 250 0 0 0 0 0 0
6 Map Folio Forte Warna Biru Pcs 400 0 0 0 0 0 0
7 Map Folio Forte Warna Kuning Pcs 250 0 0 0 0 0 0
8 Map Folio Forte Warna Merah Pcs 600 0 0 0 0 0 0
9 Map Folio Forte Warna Putih Pcs 100 0 0 0 0 0 0
10 Map Plastik Jepit Business File pcs 50 0 0 0 0 0 0

User Warehouse/Inventory
Note:
(1)
Outstanding delivery are parts that had been order but not yet delivered and not yet included in the stock on hand (out standing underlivered PO)
(2)
IF L>N ( ULY>NEW STOCK) is a "Yes", it mean it is okay to order
(3)
If there are equivalent part (same fuction) then user must provide the other group code as well.

Site GPM, 10 Oktober 2017

Request by, Prepared by, Approved by,

Officer Div. Manager Administration Manager

 QTY (P)
IS(2)
Last MRIS Last MRR Accepta User
ULY>NEW Special
ble Request Equipment
STOCK

L>N Date Qty Dat Qty O P

e

User
Stock Verified by,

Officer W/I Chief Warehouse

 No : AD G 1700045
1700012
17
Purchase Requisition Company : PT.GPM
Department : Administration ADMINISTRATION
Division : Medical Group
Date : 12
30 Agustus
15 Januari 2017
Oktober 2017
Pages : 02 of 02
11
12
Time Required :

Stock
No
Code
Description Qty (P) Unit Remarks/Justification

1 Kertas size F4 10 Rim

2 Kertas size A4 10 Rim
3 Kertas size Letter 3 Rim
4 Kertas size A3 2 Rim
5 Map Folio Forte Warna Hijau 250 Pcs
6 Map Folio Forte Warna Biru 400 Pcs
7 Map Folio Forte Warna Kuning 250 Pcs
8 Map Folio Forte Warna Merah 600 Pcs
9 Map Folio Forte Warna Putih 100 Pcs
10 Map Plastik Jepit Business File 50 Pcs

By User By User

Requested by, Approved by, Accepted by,

Accepted by,

_________________ _______________ __________________ _________________

Officer / Section Head Division Manager Adm.Manager Purchasing Manager
_________________
Date : Purchasing Manager
Date : Date : Date
Date :
Copy Distribution : 1. Purchasing Jakarta 2. End User
 No. RPR : ADG 17 00045
No. PR :
JUSTIFICATION PURCHASE PAGE

Total
Unit to
No. Part Name Unit Unit Total Unit Calculation & Explanation
Purchase
Needed

Untuk Kebutuhan ATK, Blangko2, Berkas

1 Kertas size F4 Rim 10 Rawat Inap, laporan2. 10
Untuk Kebutuhan ATK, Blangko2, Berkas
2 Kertas size A4 Rim 10 Rawat Inap, laporan2. 10
3 Kertas size Letter Rim 3 Untuk Kebutuhan surat menyurat 3
4 Kertas size A3 Rim 2 Untuk Kebutuhan pembuatan laporan 2
Mengganti Map Rekam Medis pasien yang
5 Map Folio Forte Warna Hijau Pcs 250 sudah rusak 250
Mengganti Map Rekam Medis pasien yang
6 Map Folio Forte Warna Biru Pcs 400 sudah rusak 400
Mengganti Map Rekam Medis pasien yang
7 Map Folio Forte Warna Kuning Pcs 250 sudah rusak 250
Mengganti Map Rekam Medis pasien yang
8 Map Folio Forte Warna Merah Pcs 600 sudah rusak 600
Mengganti Map Rekam Medis pasien yang
9 Map Folio Forte Warna Putih Pcs 100 sudah rusak 100

Untuk Kebutuhan Laporan BPJS Kesehatan,

Klaim Rawat inap, dan Map TTD Bukti
Pelayanan Pasien BPJS kesehatan
10 Map Plastik Jepit Business File Pcs 50 50

Site GPM/SIL/ILP, 12 Oktober 2017

Request by, Prepared by, Approved by,

Officer Div. Manager Dep. Manager/ Coord. Manager