Ver17-1 Chemical Purchase Request Form (with Quotation) July 2017

Order Amount S$ Quotation Notes

< 3K 1 Requestor should assess that the price is reasonable, if not, more quotes should be obtained
3K to 5K 3 The lowest offer which meets requestor’s requirements shall be selected; otherwise justifications will be required. The
selection shall be based on like-for like comparison
≥ 5K ITQ Attached Specifications, at least one indicative quotation and other required documents
[Process: Specs + COC + required doc.  CPO  Evaluate & Award Approvals PO]

Name of Requestor: Title:Ph.D student Tel/Mobile:97532786 Email: E0013211@u.nus.edu

Yin Zhenyuan
Lab Technologist in-charge: Liew Jian Siong Date: 08/11/2017 Delivery location: WS2-04-05 Remarks: N/A

Chemical Category Declaration by:

Chemical Weapon Convention List: PI needs to get Approval from OSHE NACWC
Singapore Police Force Explosive Precursors List: A copy of FoE EP EP “I have checked against the latest Online Regulated
License with ChBE Authorized License Holder (ALH) Material Identifier (ORMI) and the Safety Data
Environmental Protection and Management Act Scheduled Hazardous EPMA HS Sheet (SDS) for the chemicals below. I am aware of
Substances List: A copy of FoE Hazardous Substance Permit with ChBE the requirements of license, use, storage, and
Authorized License Holder (ALH)
disposal of the chemicals listed below and will
Petroleum & Flammable Materials List: A copy of OSHE P&FM License P&FM
ensure compliance with the requirements.”
with ChBE Authorized License Holder (ALH)
Health Sciences Authority Poisons Act Chemicals List: A copy of FoE POISONS
If ordering explosive precursor (EP) chemicals, I will
Poisons License with ChBE Authorized License Holder (ALH) and only order from approved vendors who can deal in
approval from FoE Safety & Health Officer for Direct Imports that EP.
Misuse of Drugs List: PI should apply the necessary license or inform CONTROLLE
the relevant authority through FoE Safey & Health Officer D DRUGS
Biological Agents & Toxins Act: Agent specific license issued by MOH to BATA Signature & Date:
PIs
Radioactive Materials : PI needs to get Approval from FoE Safey & RM
Health Officer
Not Found in any of the Above: Not found in any NUS license/ permit, Not Found
or/ and need special licensing/ permit
Item Item Description (Proper name, brand & cat No) SDS from CAS No Existing Order Unit Total $ Chemical
# vendor? Qty Qty ** Price (before GST) Category

Evaluation and Recommendation of Quotes:

*Justifications for award: A. <S$3k and price is reasonable B. Lowest of 3 offers C. Sole supplier D. Other
Supplier to award to: Item# Grand Total $ *Justifications for award WBS GL No.
Before GST

PI’s approval Endorsement of account Verified by Dept Approving Officer

(if necessary) (For uncommitted orders)
Name Mdm Tay YK Dr Ti HC
Signature
& Date

**Please be reminded of Section 7.3 of the NUS Chemical Safety Manual which stipulates prudent chemical purchase and the minimization of
chemical inventory