CAPEX Form v1

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LA SALLE UNIVERSITY OZAMIZ, INC.

CAPITAL EXPENDITURE REQUEST


Date Prepared: Form: PR03-PO (2018)
Department/Unit: Installation/construction location:

CAPEX Description:
Date Required: Type: oNew oReplacement oMajor Repairs Funding: oInternal oExternal

A. Materials
Description of Material Qty. Unit Cost Amount

Total materials -
Comments on quality requirements and/or suppliers to choose from.

B. Labor / Installation costs


Please select one or a combination: oInternal oExternal Amount
1. As a percentage of materials Percentage rate __________
2. Daily labor rate No. of workers: ________ Rate per person: ____________ No. of days: _____
3. Other, please specify : ________________________________________________________________
NOTE: If labor and/or installation costs will be externally sourced, please complete the Total Labor/Installation costs
Payment Request Form and attach an approved copy of this requisition form.

C. Total CAPEX costs Approved budget: ____________________

Noted by Recommending approval Approved by

Name: Name: Name: Benedicto P. Saligan Name: Elsie L. Dajao, DA


Title: Title: Principal / VC for Administration Title: VP for Finance Title: Chancellor
Prepare in duplicate. Copy 1: Purchasing Office (to be attached to PO). Copy 2: Requisitioning Department/Unit.

Instructions:
1. Use this form for purchases of machinery, equipment, furniture & fixture, and constructions materials of self-constructed projects,
with an aggregate estimated cost of more than ₱50,000.
2. Complete all applicable sections. If necessary, consult with the Purchasing Officer. If you have done an online research on the
requested items, print out the necessary web pages and attach to the request form.
3. Verify that this order is being submitted in entirety and not split into multiple requisitions unless designated as a multi-phase project.
4. For items that require installation/set up, do not forget to include such costs. Use Section B.
5. Review compliance against Purchasing policies and procedures.
6. The Integrated School Principal must sign for all request from any departments/units in Basic Ed. The VC for Administration must
sign for all other requests.
7. Retain a copy of approved PR03-PO and any supporting documents.
8. Submit all accompanying supporting documents with necessary signatures of approval to Purchasing Officer.

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