PURCHASE REQUISITION FORM

Funding source: Date Prepared: 23/04/2021

Activity detail:
Cleaning materials - Monthly Purchase For Finance Only;
Budget code Description of goods/services Specifications Quantity Date required Preferred supplier Available budget Selected supplier Unit cost Total cost
Toilet tissues cartoons 1 1-May-2021 Muhsin Genernal .S 330000
Toilet balls boxes 1 1-May-2021 Muhsin Genernal .S 60000
Air freshener boxes 1 1-May-2021 Evarest Cleaning .S 84000
Harpic pieces 6 1-May-2021 Muhsin Genernal .S 51000
Liquid soap jerrycans 5 1-May-2021 Mushin General . S 125000
Green pads boxes 1 1-May-2021 Mushin General .S 60000
Foam soap liters 5 1-May-2021 Mushin General .S 95000
Polythen bags small packets 5 1-May-2021 Muhsin Genernal .S 25000
Polythen bags big packets 1 1-May-2021 Muhsin Genernal .S 20000
Mopping towels pieces 3 1-May-2021 Muhsin Genernal .S 75000
Small towels pieces 5 1-May-2021 Muhsin Genernal .S 25000
Climax dozens 6 1-May-2021 Mushin General . S 102000
Sacks packets 1 1-May-2021 Mushin General . S 20000

TOTALS 1072000

TOTALS

Requisitioned by: Supervisor approval Quotations obtained by (Procurement)

Name Phyllis Nassuna Name Allan Okello Name

Signature Signature Signature

Position/Title Tukole Lead Position/Title Business lead Position/Title

Date 23/04/2021 Date 23/04/2021 Date

Reviewed by; Approved by:

Name . Name

Signature Signature

Position/Title Position/Title

Date Date