Form No.

:
FORM PURCHASE REQUISITION
Revision No. :
PT. Pakubumi Inti Mineral Date :

Request by :
Request to :
Attn. :
Date :
Reason For Purchase :

No. Deskripsi Jumlah Satuan Harga Satuan Sub Total Total Keterangan
1
2
3
4
5
6
7
Rp -

Requested by, Checked by, Approved by,

( ……………………. ) General Affairs Direktur

 Form No. :
FORM PURCHASE REQUISITION
Revision No. :
PT. PAKUBUMI INTI MINERAL Date :

Request by :
Request to :
Attn. :
Date :
Reason For Purchase :

No. Deskripsi Jumlah Satuan Harga Satuan Sub Total Total Keterangan

Requested by, Checked by, Approved by,

( ……………………. )