DEPARTMENTAL REQUEST FORM

ORIGINATING DIRECTORATE/DEPARTMENT

Prepared by

Name

Monica Nannyomo

Job Title

Logistics Assistant

Date

00-00-00

Approved by

Name

Monica Nannyomo

Job Title

Logistics Assistant

Date

00-00-00

Director

Name

Monica Nannyomo

Job Title

Logistics Assistant

Date

00-00-00

Timeframe when goods and services needed

Approved by

Executive Director

(Where applicable per Approval authority level)

S/no

Descriptions of Goods and Services(Include specifications for unique products)

Unit Cost (Shs)

Qty

Estimated Unitcost

Funding Source

Cost Code

Department Code

BUDGET CONTROL CHECK(Grants Finance Department)

Checked by

Name

Job Tile

Signature

Date

Budget Control Cosiderations

Cost allowability

Budget allowability

Comments

FOR SUPPLY CHAIN MANAGEMENT DEPARTMENT USE ONLY

Received by

Name

Job Title

Signature

Date

Comments

Mode of procurement

Framework Aggrements

LPO Number

Open Tendering

Direct Procurement

Single Sourcing

Purchase Request Level

Approval Authority

Purchase Request Level

Approval Authority

Up to Shs 50,000,000

Directors

Unbudgeted Expenditure above Shs 20million

Board of Directors

Above Shs 50,000,000

Executive Director

Capital Purchases Except Real Estate/Fleet

Executive Director

Unbudgeted Expenditure less than Shs 20million

Executive Director

Real Estate Acquisition of Land, Buildings and Fleet Acquisition

Board of Directors

All expenses shall carry a lead time of between 14 to 30 days: Adequate planning is required