FORM 5

Regulation 3(5), 12 (3), 13(3), 14(4),

15(4), 17(2), 44 (5), 45(4)
THE PUBLIC PROCUREMENT AND DISPOSAL OF PUBLIC ASSETS ACT, 2003
REQUEST FOR APPROVAL OF PROCUREMENT
PART I: REQUEST BY USER DEPARTMENT FOR APPROVAL OF PROCUREMENT
Procurement Reference Number
Code of Procuring and
Supplies/Works/NonFinancial year
Sequence number
Disposing Entity
consultancy services

Particulars of Procurement
Subject of Procurement
Procurement

Plan

Reference
Location for Delivery
Date Required

Page 1 of 4

Details relating to the Procurement

Item
No.

Description

Quantity

Unit of
Measure

(Attach specifications, terms of reference or scope of works)

Estimated
Unit Cost

Market price
of the
procurement

Currency:__________
Estimated Total Cost:
(1) Request for Procurement
(Member of user department)

(2)

Confirmation of request
(Head of user department)

Name:
_____________________________
Signature: _____________________________

_____________________________
_____________________________

Title:
Date:

_____________________________
____________________________

_____________________________
_____________________________

Availability of funds to be confirmed prior to approval by Accounting Officer:

Vote/head No

Programme

Sub-programme

(3) Confirmation of funding and approval to procure

(Accounting Officer)
Name:
Signature:
Title:
Date:

_____________________________
_____________________________
_____________________________
_____________________________
Page 2 of 4

Item

Balance remaining

PART II: REQUEST BY PROCUREMENT AND DISPOSAL UNIT TO CONTRACTS COMMITTEE FOR
APPROVAL OF PROCUREMENT METHOD
Submission by the Procurement
and Disposal Unit
Date of submission to Contracts
Committee:
1.

Recommended method of
procurement and justification

2.

Names of shortlisted provider (s)

and justification for selection

3.

Bidding
document.
Persons
involved in preparation of
proposal document (Names and
positions)

4.

Names of persons recommended

to constitute the Evaluation
Committee and the justification
(Names and positions)

5.

Cost of the bidding document, if

any

6.

Any other information

Page 3 of 4

Decision by the
Contracts
Committee
Date/reference of
Contracts Committee
meeting:

Conditions/
Justification for
decision

Documents attached:
1. Bidding Document
Declaration by Procurement and Disposal Unit
The information contained in this form and the attached
documents is complete, true and accurate and in accordance
with the Public Procurement and Disposal of Public Assets Act,
2003.

Declaration by Contracts Committee

The information contained in this form is a true and accurate
record of the decision of the Contracts Committee meeting held
on the above date.

Name:

_____________________

Name:

_____________________

Position:

_____________________

Position:

Chairperson Contracts Committee

Signature:

_____________________

Signature:

_____________________

Date:

_____________________

Date:

_____________________

Name:

_____________________

Position:

Secretary Contracts Committee

Signature:

_____________________

Date:

_____________________

Page 4 of 4