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TITLE OF FORM:

Number of pages: Procedure Number


Prepared by: Date: Approved by: Date:
Designation Designation

AHJA Distributors
Goods Receival Form
Requisition no. _____________________________________ Institution: __________________________________

Name of requisitioning officer: _________________________ Date: ______________________________________

Delivery note no: ___________________________________ Total number of packages: _____________________

Handed over by (name): ______________________________ Date ______________________________________

Received by (name): _________________________________ Date ______________________________________

Item description Unit of Unit Quantity Total Quantity Total Signature Remarks
issue price ordered price delivered price

Name and signature of receiving officer: _____________________________________________________________

Name and signature of witness: ____________________________________________________________________

Review Date:
Date Reviewed:
Signature: