MITRA QUALITY SAFETY HEALTH ENVIRONMENT MANAGEMENT SYSTEM

FORMULIR
PERMINTAAN PEMBELIAN BARANG/JASA (PURCHASE REQUISITION FORM)
Nomor/Number (Automaticaly)
Departemen / Department Deck/ Engine/Galley/Crane/Other :
Tempat-Tanggal / Place-Date
Alasan Penggantian (jelaskan kenapa melakukan pembelian.
Contoh: valve bocor, suhu melebihi standar,korosi akibat air
laut,Pipa bocor dikarenakan seal tidak bagus, oli berubah warna
karena tercampur air) /Reason for Replacement (Explain why need
to making Purchase. Example : Leaked Valve, Over Heat, Corrotion,
The Valve is leaking because the seal is not good, the oil changes
color because it is mixed with water)
Ekspektasi Estimasi lokasi
No. Pabrik Keterangan Barang/Jasa Request Purpose Budget
Jumlah Tanggal Pengiriman Material Jumlah Tanggal Tanggal
Satuan/ VHS/Invento Initial
Contoh / Exam: Spesifikasi Detail, Serial Perminta Penerimaan berikutnya Number/No. yang di Terakhir Terakhir Initial
Manufacture Measurem Merk/Brand ry/ Direct Manager/
Number, Model, Attachment/ IMPA Number, an/ Barang/ /Expectation Material setujui/ dikirim Permintaan/ Status Status Manager/
Number ent Unit Purchase Paraf
Dimensi (ukuran) dan Foto barang Req.Qty Expectation Delivery Next Number Aprv Qty. /Last Supply Last Request Paraf Manager
Manager
received date Location

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Regular Budget
Emergency Not Budget

Disetujui oleh / Approved by Site

Diminta oleh / Requested by Diverifikasi oleh / Verified PE/PC
Rep/ Manager

- White area for User / Area Putih diisi oleh User

Note: - Red Area for PE/PC / Area Merah diisi oleh PE/PC
- Blue Area for Manager / Area Biru diisi oleh Manager

Nama/ Name: Nama/ Name: Nama/ Name:

Jabatan/Position : Jabatan/Position : Jabatan/Position :