Republic of the Philippines Document Code:

Department of Education SCC-QF-OSDS-S

Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY
Effectivity date: 07
San Carlos City
Name of Of
PURCHASE ORDER
OSDS – SUPPLY
Reference No.:___________________________________ Date: ___________
Supplier : MARIGOLD STORE P.O. No. : 2019-01-07
Address : _____________________________________ Date : 03-26-2019
TIN : ________________________________________________
DAGUPAN CITY, PANGASINAN Mode of Procuremen
Please furnish 157-686-860-002
this Office the following articles subject to the terms and conditions contained herein:
Place of Delivery : SEPNAS Delivery Term :
Date of Delivery : 03-27-2019 Payment Term :

Item Stock /
Property Unit Description Quantity
No.
1 pcs GLUE GUN 1
2 pcs GLUE STICK 220
3 roll RIBBON EMERALD GREEN 1/2 1
4 roll RIBBON GOLD 1" 1
5 kilo GLITTERS SILVER 1
6 kilo GLITTERS GOLD 1
7 cans BOSNYK SPRAY PAINT RED 20
8 units SELF-INKING STAMP 3
9 pcs ADJUSTABLE STICKEE GLUE 10
10 pcs JOY CORRECTION TAPE 10
11 bxs PILOT PENTEL PEN BLUE AND BLACK FINE 2
12 box MYGEL SIGNPEN BLUE 1
13 pcs JOY STAMP PAD BLACK 2
14 pcs SLIDING FOLDER GREEN LEGAL SIZE 96
15 bxs NOTARIAL SEAL #23 40
16 unit SELF-INKING STAMP 1
17 pcs ENVELOPE BROWN LEGAL SIZE 600

Total Amount
(Total Amount in Words FOURTEEN THOUSAND FIVE HUNDRED SIXTY THREE PESOS ONLY

In case of failure to make the full delivery within the line specified above, a penalty of one-tenth(1/10) of one
 percent for everyday of delay shall be imposed.

Conforme: Very truly yours,

MARIGOLD STORE MARITES V. CABATBAT

Signature over Printed Name of Supplier School Principal IV
3-26-2019
ORS/BURS No. : _____________
Funds Available : Date of the ORS/BURS: _______

MA. JHONALYN J. SORIANO JULIEN BERNARD GONZALES Amount : 14,563.00

ACCOUNTANT I ADMINISTRATIVE OFFICER IV
Document Code: SDO-
SCC-QF-OSDS-SUP-002
Revision: 00
Effectivity date: 07-01-18
Name of Office:
OSDS – SUPPLY OFFICE
Date: ______________
.O. No. : 2019-01-07
Date : 03-26-2019
Mode of Procurement : Shopping

Delivery Term : cod

ayment Term : cash

Unit Cost Amount

320.00 320.00
10.00 2,200.00
80.00 80.00
85.00 85.00
600.00 600.00
600.00 600.00
168.00 3,360.00
368.00 1,104.00
30.00 300.00
33.00 330.00
444.00 888.00
300.00 300.00
40.00 80.00
8.00 768.00
45.00 1,800.00
398.00 398.00
2.25 1,350.00

Total Amount 14,563.00

enth(1/10) of one
V. CABATBAT

No. : ______________________
e ORS/BURS: _______________
 Republic of the Philippines Document Code:
Department of Education SCC-QF-OSDS-S
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY
Effectivity date: 07
San Carlos City
Name of Of
PURCHASE ORDER
OSDS – SUPPLY
Reference No.:___________________________________ Date: ___________
Supplier : MARIGOLD STORE P.O. No. : 2019-04-10
DAGUPAN CITY, PANGASINAN
Address : _____________________________________ Date : 03-26-2019
TIN : ________________________________________________
157-686-860-002 Mode of Procuremen
Please furnish this Office the following articles subject to the terms and conditions contained herein:
Place of Delivery : SEPNAS Delivery Term :
Date of Delivery : 03-26-2019 Payment Term :

Item Stock /
Property Unit Description Quantity
No.
1 units SELF-INKING STAMP 3
pcs ADJUSTABLE STICKEE GLUE 10
pcs JOY CORRECTION TAPE 10
bxs PILOT PENTEL PEN BLUE AND BLACK FINE 2
box MYGEL SIGNPEN BLUE 1
pcs JOY STAMP PAD BLACK 2
pcs SLIDING FOLDER GREEN LEGAL SIZE 96
NOTARIAL SEAL #23
SELF-INKING STAMP
ENVELOPE BROWN LEGAL SIZE

Total Amount
(Total Amount in Words THREE THOUSAND SEVEN HUNDRED SEVENTY PESOS ONLY

In case of failure to make the full delivery within the line specified above, a penalty of one-tenth(1/10) of one
 percent for everyday of delay shall be imposed.

Conforme: Very truly yours,

MARIGOLD STORE MARITES V. CABATBAT

Signature over Printed Name of Supplier School Principal IV
3-26-2019
ORS/BURS No. : _____________
Funds Available : Date of the ORS/BURS: _______

MA. JHONALYN J. SORIANO JULIEN BERNARD GONZALES Amount : 3,770.00

ACCOUNTANT I ADMINISTRATIVE OFFICER IV
Document Code: SDO-
SCC-QF-OSDS-SUP-002
Revision: 00
Effectivity date: 07-01-18
Name of Office:
OSDS – SUPPLY OFFICE
Date: ______________
.O. No. : 2019-04-10
Date : 03-26-2019
Mode of Procurement : Shopping

Delivery Term : cod

ayment Term : cash

Unit Cost Amount

368.00 1,104.00
30.00 300.00
33.00 330.00
444.00 888.00
300.00 300.00
40.00 80.00
8.00 768.00

Total Amount 3,770.00

enth(1/10) of one
V. CABATBAT

No. : ______________________
e ORS/BURS: _______________
 Republic of the Philippines Document Code: SDO-
Department of Education SCC-QF-OSDS-SUP-001
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY
San Carlos City Effectivity date: 07-01-18
Name of Office:
PURCHASE REQUEST OSDS – SUPPLY OFFICE
Reference No.:_____________ Date:

Entity Name: Speaker Eugenio Perez National Agricultural School Fund Cluster: ______________
Office/Section : PR No.: 2019-01-07 Date: 03-25-2019
Reference No.
Responsibility Center Code : 01101101 __________
Stock/
Prope Quanti Unit Cost
Item rty Unit Item Description ty Total Cost
No.
1 pcs GLUE GUN 1 320.00 320.00
2 pcs GLUE STICK 220 10.00 2,200.00
3 roll RIBBON EMERALD GREEN 1/2 1 80.00 80.00
4 roll RIBBON GOLD 1" 1 85.00 85.00
5 kilo GLITTERS SILVER 1 600.00 600.00
6 kilo GLITTERS GOLD 1 600.00 600.00
7 cans BOSNYK SPRAY PAINT RED 20 168.00 3,360.00
8 units SELF-INKING STAMP 3 368.00 1,104.00
9 pcs ADJUSTABLE STICKEE GLUE 10 30.00 300.00
10 pcs JOY CORRECTION TAPE 10 33.00 330.00
11 bxs PILOT PENTEL PEN BLUE AND BLACK FINE 2 444.00 888.00
12 box MYGEL SIGNPEN BLUE 1 300.00 300.00
13 pcs JOY STAMP PAD BLACK 2 40.00 80.00
14 pcs SLIDING FOLDER GREEN LEGAL SIZE 96 8.00 768.00
15 bxs NOTARIAL SEAL #23 40 45.00 1,800.00
16 unit SELF-INKING STAMP 1 398.00 398.00
17 pcs ENVELOPE BROWN LEGAL SIZE 600 2.25 1,350.00

Total Amount 14,563.00

PURPOSE: Materials used for moving up, recognition and graduation day's stage decorations

Requested by: Approved by:

Signature :
Printed Name JULIEN BERNARD GONZALES MARITES V. CABATBAT
Designation : Administrative Officer IV School Principal IV

Document Code:
Revision:
Effectivity Date:
 ꝊØ

14165
40 17520
5485
2490
39660

30

39655

8580

48235

70
 Republic of the Philippines Document Code: SD
Department of Education SCC-QF-OSDS-SU
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-0
San Carlos City
Name of Office
INSPECTION AND ACCEPTANCE REPORT
OSDS – SUPPLY O
Reference No.: _________________ Date: _____________
Supplier MARIGOLD STORE AR No. ___________
Address : Dagupan City, Pangasinan
P.O. No. 2019-01-07 Date: 3-28-2019 Invoice No. 102883
Requisitioning Office/Dept. Division of City Schools
Stock /
Item No. Description Unit
Property No.
1 GLUE GUN pcs
2 GLUE STICK pcs
3 RIBBON EMERALD GREEN 1/2 roll
4 RIBBON GOLD 1" roll
5 GLITTERS SILVER kilo
6 GLITTERS GOLD kilo
7 BOSNYK SPRAY PAINT RED cans
8 SELF-INKING STAMP units
9 ADJUSTABLE STICKEE GLUE pcs
10 JOY CORRECTION TAPE pcs
11 PILOT PENTEL PEN BLUE AND BLACK FINE bxs
12 MYGEL SIGNPEN BLUE box
13 JOY STAMP PAD BLACK pcs
14 SLIDING FOLDER GREEN LEGAL SIZE pcs
15 NOTARIAL SEAL #23 bxs
16 SELF-INKING STAMP unit
17 ENVELOPE BROWN LEGAL SIZE pcs
-

Date Inspected: ____________ Date Received: ____________

Inspected, verified and found OK as to Complete
quantity and specifications
 Inspected, verified and found OK as to
quantity and specifications Partial

MARLOW V. GREGORIO JULIEN BERNARD GONZALES

Inspection Team Leader A.O. IV, Supply Officer
EVELYN L. MENDOZA MARICOR U. SANCHEZ DESIGNATE
Inspection Team Member Inspection Team Member
 de: SDO-
DS-SUP-003

e: 07-01-18
Office:
PLY OFFICE
_________
__________

Quantity
1
220
1
1
1
1
20
3
10
10
2
1
2
96
40
1
600
 Republic of the Philippines
Document Code: SDO-
Department of Education SCC-QF-OSDS-BAC-001
Region I
SCHOOLS DIVISION OF SAN CARLOS CITY Revision: 00
San Carlos City, Pangasinan Effectivity date: 07-23-18

Request for Quotation Name of Office: OSDS-

BAC OFFICE

Reference No:________________ March ____ 2019

Date

Address

Please quote the current price of the following items described below for the use by this office in
the purchase of the same. Quotation should either be handed to any of the following canvasser
and submitted to this office not later than ___________A.M/P.M to be opened and read in the
presence of the representative of the manager and the undersigned

MARITES V. CABATBAT
School Principal IV

Quantity Unit Article Unit Price Total Prce

1 pcs GLUE GUN
220 pcs GLUE STICK
1 roll RIBBON EMERALD GREEN 1/2
1 roll RIBBON GOLD 1"
1 kilo GLITTERS SILVER
1 kilo GLITTERS GOLD
20 cans BOSNYK SPRAY PAINT RED
3 units SELF-INKING STAMP
10 pcs ADJUSTABLE STICKEE GLUE
10 pcs JOY CORRECTION TAPE
2 bxs PILOT PENTEL PEN BLUE AND BLACK FINE

1 box MYGEL SIGNPEN BLUE

2 pcs JOY STAMP PAD BLACK
96 pcs SLIDING FOLDER GREEN LEGAL SIZE
40 bxs NOTARIAL SEAL #23
1 unit SELF-INKING STAMP
600 pcs ENVELOPE BROWN LEGAL SIZE

Total
Training Title:
Purpose:
Materials used for moving up, recognition and graduation day's stage decorations
Note:
This must be placed in an envelope duly sealed with signature of the supplier across the slip
before it is handed to the canvass

Signature of Delaer
 Republic of the Philippines Document Code: SDO-
Department of Education SCC-QF-OSDS-SUP-004
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Office:
REQUISITION AND ISSUE SLIP
OSDS – SUPPLY OFFICE
Reference No.: _________________ Date: ________________

Entity Name : Fund Cluster : ________________

Division : ______________________________________________Responsibility Center Code : _________________

Office : ______________________________________ RIS No. : _____________________________________
Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity Remarks
 Purpose:

Requested by: Approved by: Issued by: Received by:

Signature :
Printed Name :
Designation :
Date :
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OF SAN CARLOS CITY
San Carlos City

REPORT OF SUPPLIES AND MATERIALS USED

Reference No.: ________________

Date: _______________________

To be filled up by In-Charge of Stockroom To be filled up by Acctg. Sta

RIS Responsibility Stock No. Unit
Item
No. Center

Recapitulation
Stock No. Quantity
Certified by: Posted by/date:

Administrative Officer IV
Document Code: SDO-
SCC-QF-OSDS-SUP-005
Revision: 00
Effectivity date: 07-01-18
Name of Office:
OSDS – SUPPLY OFFICE
Date: ________________

No.____________________

To be filled up by Acctg. Staff

Qty. Issued Unit Cost Amount

Recapitulation:
Unit Cost Total Cost Account No.
Posted by/date:

Accounting Clerk
 Republic of the Philippines
Document Code: SD
Department of Education
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01
San Carlos City
Nam
INVENTORY AND INSPECTION REPORT OF UNSERVICEABLE PROPERTY
OSDS – S

Reference No.: _________________ Date: _____________

_______________________
Office Name of Accountable Officer Designation

INVENTORY INSPECTION REPOR

DISPOSITION
Articles Quantity Unit Cost Total Cost Property Date No. of yrs. Accumulated Sale Barter Transfer to Destruction/
Number Acquired in service Depreciation other gov't. Condem-
Agency nation
1 2 3 4 5 6 7 8 9 10 11 12
 I HEREBY request inspection, and disposition I CERTIFY that I have inspected each and every
pursuant to Section 79 of PD 1445, of the property article enumerated in this report and that the
of which the above is the correct inventory and which Disposition made thereof was, in my judgement, the
has not been previously condemned. best for the public interest.

Requested by: REQUEST FOR INSPECTION APPROVED BY:

MARIA CRISTINA N. MAMORNO SHEILA MARIE A. PRIMICIAS, CESO VI ________________________________________________

Administrative Officer IV - Supply Officer Schools Division Superintendent
Document Code: SDO-SCC-QF-OSDS-SUP-006
Revision: 00
Effectivity date: 07-01-18
Name of Office:
OSDS – SUPPLY OFFICE

Date: ________________

______________________________
Classification

Station

INSPECTION REPORT
ION
Appraisal Official Amount
Receipt
Number
13 14 15 16
I CERTIFY that I have withnessed the disposition
of the articles enumerated on this report this
_______ day of ____________, ________.

_____________________________________
Commission On Audit
 Republic of the Philippines Document Code: SDO-SCC-QF-
Department of Education OSDS-SUP-007
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
REPORT OF LOST, STOLEN, DAMAGED OR Name of Office:
DESTROYED PROPERTY OSDS – SUPPLY OFFICE
Reference No.: ________________ Date: ________________

Appendix 75
Fund Cluster: _____________
Entity Name : __________________________

Department/Office : ___________________________________________ RLSDDP No. : ______________

Accountable Officer : _________________________________________ RLSDDP Date : _____________
Designation : ________________________________________________ PAR No. : _________________
Police Notified : Yes Police Station : ____________________ PAR Date : ________________
Date : ___________________________
No

Status of Property : (check applicable box)

Lost Damaged
Stolen Destroyed

Property No. Description Acquisition Cost

Circumstances:

I hereby certify that the item/s and circumstances stated above are true and
correct. Noted by:

__________________________________________ __________________________________
Signature over Printed Name of the Accountable Officer Signature over Printed Name of the Immediate Supervisor
________________ ________________
Date Date

Government Issued ID : __________________

ID No. : _____________________________
Date Issued : _________________________

SUBSCRIBED AND SWORN to before me this ______day of _____________, affiant exhibiting the above
government issued identification card.
Doc. No. _________
Page No. _________ _______________________
Book No. _________ Notary Public
Series of _________
 Republic of the Philippines Document Code: SDO-
Department of Education SCC-QF-OSDS-SUP-008
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Office:
PROPERTY TRANSFER REPORT
OSDS – SUPPLY OFFICE
Reference No.: ________________ Date: ________________

Appendix 76
Entity Name : _______________________________ Fund Cluster : _____________

From Accountable Officer/Agency/Fund Cluster : __________________________ PTR No. : ______________

To Accountable Officer/Agency/Fund Cluster : ____________________________ Date : _________________

Transfer Type: (check only one)

Donation Relocate
Reassignment Others (Specify) _________________

Condition of
Date Acquired Property No. Description Amount
PPE
Reason for Transfer:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________

Approved by: Released/Issued by: Received by:

Signature :
Printed Name :
Designation :
Date :
 Republic of the Philippines Document Code: SDO-
Department of Education SCC-QF-OSDS-SUP-009
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Office:
STOCK CARD
OSDS – SUPPLY OFFICE
Reference No.: ________________ Date: ________________

Entity Name: ___________________________________ Fund Cluster: _________

Item : Stock No. :

Description : Re-order Point :
Unit of Measurement :
Receipt Issue Balance No. of Days to
Date Reference
Qty. Qty. Office Qty. Consume
 Republic of the Philippines
Document Code: SDO-SCC-QF
Department of Education
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Offic
SUPPLIES LEDGER CARD
OSDS – SUPPLY O

Reference No.:__________________________________________ Date: ______________________

Entity Name : ____________________________________ Appendix

Fund Cluster : ________________

Item : Item Code :

Description : Re-order Point :
Unit of Measurement :
Receipt Issue Balance
Date Reference Unit Unit Unit
Qty. Total Cost Qty. Total Cost Qty.
Cost Cost Cost
CC-QF-OSDS-SUP-010

of Office:
UPPLY OFFICE

_____

ndix 57
________

No. of Days
to
Total Cost
Consume
 Republic of the Philippines Document Code: SDO-S
Department of Education OSDS-SUP-011
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY
Effectivity date: 07-01-18
San Carlos City
Name of Office:
INVENTORY CUSTODIAN SLIP
OSDS – SUPPLY OF
Reference No.: ________________ Date: ________________

Entity Name: _______________________________

Fund Cluster : ________________________________ ICS No : ________________

Amount
Inventory Item
Quantity Unit Unit Total Description
No.
Cost Cost
1 pcs GLUE GUN
220 pcs GLUE STICK
1 roll RIBBON EMERALD GREEN 1/2
Received from: Received by:

LILIAN B. MANDAPAT ______________________

Signature Over Printed Name
Administrative Officer I - Supply Officer
Position/Office
Date
Signature Over Printed
______________________
Position/Office
______________________
Date
nt Code: SDO-SCC-QF-
UP-011
: 00
y date: 07-01-18
Name of Office:
S – SUPPLY OFFICE
______________

_______________________

Estimated Useful
Life
 ______________________
ture Over Printed Name
______________________
Position/Office
______________________
Date
 Republic of the Philippines Document Code: SDO-SCC
Department of Education OSDS-SUP-012
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Office:
PROPERTY ACKNOWLEDGMENT RECEIPT
OSDS – SUPPLY OFF
Reference No.: ________________ Date: ________________

Entity Name : ______________________________________

Fund Cluster: ______________________________________ PAR No.: ________________

Property Date
Quantity Unit Description Amoun
Number Acquired
 Received by:
_________________________________________
Signatue over Printed Name of End User
__________________________________
Position/Office
_________________________
Date
Issued by:
______________________________________
Signatue over Printed Name of Supply and/or Pr
Custodian
_______________________________
Position/Office
_________________________
Date
SDO-SCC-QF-

7-01-18
of Office:
PPLY OFFICE
______

Appendix 71

__________

Amount
______________
ply and/or Property
________

_____
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OF SAN CARLOS CITY
San Carlos City

REPORT ON THE PHYSICAL COUNT OF PROPERTY, PLANT AND EQUIPMENT

Reference No.: _________________

________________________________
(Type of Property, Plant and Equipment)
As at ________________________________

Fund Cluster : ________________________________

For which ___(Name of Accountable Officer)__, _ (Official Designation)___, _______(Entity Name)________ is accountable, having assumed such accountability on _(Date of A

QUANTITY QUANTITY
PROPERTY UNIT OF UNIT SHORTAGE/OVERAGE
ARTICLE DESCRIPTION per per
NUMBER MEASURE VALUE
PROPERTY CARD PHYSICAL COUNT Quantity Value
Certified Correct by: Approved by: Verified by:

________________________
Signature over Printed Name of Signature over Printed Name of Head of Signature over Printed Name
Inventory Committee Chair and Agency/Entity or Authorized Representative Representative
Members
 Document Code: SDO-SCC-
QF-OSDS-SUP-013
Revision: 00
Effectivity date: 07-01-18
Name of Office:
OSDS – SUPPLY OFFICE
Date: ________________

Appendix 73

ccountability on _(Date of Assumption).

REMARKS
_____________________________
gnature over Printed Name of COA
Representative
 Republic of the Philippines Document Code: SDO-
Department of Education SCC-QF-OSDS-SUP-014
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Office:
REPORT ON THE PHYSICAL COUNT OF INVENTORIES
OSDS – SUPPLY OFFICE
Reference No.: _________________ Date: ________________

__________________________________________
Type of Inventory Item
As of ___________________________

For which __________________________________________________ is accountable, having assumed such accountability on ___________________________

BALANCE ON HAND SHORTAGE/OVERAGE

STOCK UNIT OF
ARTICLE DESCRIPTION UNIT VALUE PER CARD PER COUNT REMARKS
NUMBER MEASURE Quantity Value
(Quantity) (Quantity)
Prepared by: Noted:

MARIA CRISTINA N. MAMORNO SHEILA MARIE A. PRIMICIAS

Administrative Officer IV - Supply Officer Schools Division Superintendent
ent Code: SDO-
F-OSDS-SUP-014
n: 00
ty date: 07-01-18
me of Office:
– SUPPLY OFFICE
______________

REMARKS
 Republic of the Philippines Document Code: SDO-
Department of Education SCC-QF-OSDS-SUP-015
Region I Revision: 00
SCHOOLS DIVISION OF SAN CARLOS CITY Effectivity date: 07-01-18
San Carlos City
Name of Office:
WASTE MATERIALS REPORT
OSDS – SUPPLY OFFICE
Reference No.: ________________ Date: ________________
Appendix 65

Entity Name : ____________________________________ Fund Cluster : ____________

Place of Storage : ___________________________________________ Date : ____________________
ITEMS FOR DISPOSAL
Record of Sales
Item Quantity Unit Description Official Receipt
No. Date Amount
1
2
3
4
5
6
7
8
9
10
TOTAL
Certified Correct : Disposal Approved :
__________________________________
Signature over Printed Name of Supply Signature over Printed Name of Head of Agency/Entity or
and/or Property Custodian his/her Authorized Representative
CERTIFICATE OF INSPECTION

I hereby certify that the property enumerated above was disposed of as follows:
 Item ________ Destroyed
Item ________ Sold at private sale
Item ________ Sold at public auction
Item ________ Transferred without cost to __(Name of the Agency/Entity)__

Certified Correct: Signature over Printed Name of Witness to Disposal:

Inspection Officer Signature over Printed Name of Witness
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OF SAN CARLOS CITY
San Carlos City

AGENCY PROCUREMENT REQUEST

Reference No.: ________________

APR FORM Revised May 2015

NAME AND ADDRESS AGENCY ACCT. CODE:
OF REQUESTING AGENCY CONTROL NUMBER:
AGENCY

TEL. NOS.: PS APR NO.:

To: PROCUREMENT SERVICE

DBM Compound, RR Road (
Cristobal St., Paco, Manila

PLEASE CHECK [√] APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

[ ] Please issue common-use supplies/ materials per Price Lilst No. _________________ dated ___________
Mode of Delivery: [ ] Pick up (Fast Lane) [ ] Pick up (Schedule) [ ] Delivery (Door-to-Door)

In case fund is insufficient: [ ] Reduce Quantity [ ] Bill Us [ ] Charge to Unutilized Deposit, APR No.: _

[ ] Please purchase for our office non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR)
[ ] Certificate of Budget Allocation (CBA) [ ] Payment

This form shall be prepared for requisitions of Common-Use goods from the Ps Depots & Sub-Depots; an
Common Use Supplies from the PS Main.
For PS Main Common-Use Supplies, please use FORM 001 R or FORM 00
ITEM NO. ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO. QUANTITY
 NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE:
WITHIN APPROVED PROGRAM:

MARIA CRISTINA N. MAMORNO BENEDICTA P. PANINGBATAN

AGENCY PROPERTY/ SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT

[ ] FUNDS DEPOSITED WITH PS [ ] ________________________________________ CHECK No. : _______________

IN THE AMOUNT OF: ______________________________________________ (₱ ___________________
 Document Code: SDO-SCC-QF-OSDS-SUP-016
Revision: 00
Effectivity date: 07-01-18
Name of Office:
OSDS – SUPPLY OFFICE
Date: ________________

FORM No. 002

NCY ACCT. CODE:
NCY CONTROL NUMBER:

APR NO.:

(Date Prepared)

EM/S LISTED BELOW

_________ dated _____________________.

] Delivery (Door-to-Door)

o Unutilized Deposit, APR No.: ___________________

Date: ______________________

[ ] Others (pls. specify): _______________

the Ps Depots & Sub-Depots; and for orders of Comsumables & Non-
s from the PS Main.
ase use FORM 001 R or FORM 001 B.
UNIT UNIT PRICE AMOUNT
 TOTAL AMOUNT: ₱ _______________________
R PRINTED NAME
APPROVED:

DR. SHEILA MARIE A. PRIMICIAS, CESO VI

AGENCY HEAD/ AUTHORIZED SIGNATURE

_ CHECK No. : ________________________________________

____ (₱ __________________________) ENCLOSED.