to Process Orders for the Private Purchase of SES Ipads; And

PRIVATE PURCHASE OF SES IPADS FBMR 8.1.5 Queensland State Emergency Service

SES group

Contact name

Contact no.

Address for delivery of order:

Email address for receipt and delivery confirmations:

Price Item description VIMS Stock code Quantity Total (incl. GST) iPad Air 2 64GB CH001 $825.00

iPad Case (Defender) CH002 $99.00

Order Total

Please note following submission of this form an invoice will be issued outlining your payment options. The order will be despatched once payment confirmation has been received by your SES Regional/Area Office.

In signing this form, the SES Local Controller (or delegate) and a Local Government Representative endorse the group’s request to purchase the item/s detailed above and acknowledge:  The SES Group / Local Government {Circle applicable} will be responsible for the data charges;  The Local Government will retain ownership of the iPad and case; and  Queensland Fire and Emergency Service (QFES) will not be responsible for the replacement of the iPad in the event it is lost, damaged, stolen or reaches the end of its useful life.

SES Local Controller (or delegate):

Name: ______Signature: ______

Position: ______Date: ______

Local Government Representative:

Name: ______Signature: ______

Position: ______Date: ______

Queensland Fire and Emergency Services is collecting the personal information on this form for the following purposes: - to process orders for the private purchase of SES iPads; and - for the Department to discharge its legislative, accountability, administrative, reporting, management, personnel and financial functions. Collection of this information is authorised/required by the Fire and Emergency Services Act 1990. For further information about privacy and other uses and disclosures of your personal information, refer to the Department’s Privacy Plan as amended from time to time, available on the Department’s website.

of 2 Date: 12/12/2016 FBMR 8.1.5 v1.0 SES REGIONAL/AREA OFFICE USE 1. Manual Stores Requisition completed and emailed to SES Logistics. 2. Invoice raised and issued to SES group. 4. Payment confirmation received and SES Logistics notified. 5. Documentation relating to the purchase maintained.

of 2 Date: 12/12/2016 FBMR 8.1.5 v1.0