SUPPLY OFFICE FORM No.

01

Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar PURCHASE REQUEST

Department/College GENERAL SERVICES UNIT Section: _______________________________

Stock No.

P.R. No. _____________Date: _____________ SAI No. _________________ Date: ________________ Purpose/Use Qty Unit Cost Total Cost

Unit

Item/Description

Pcs Kls Ltr Pcs

Corr. G.I Sheet 8 Umbrella Nails Vulcaseal Ridge Roll(gidge 26)

Materials for the repair of roofing at the College of Veterinary Medicine, Anatomy Laboratory room.

30 10 1 21

P 400.00 80.00 450.00 350.00

P 12,000.00 800.00 450.00 7,350.00

Noted :

DR. BALTAZAR G. MARTIRES VP for Administration and Finance

Total: Fund for this purchase request is: Available Not Available

P 20,600.00
The requested item/s is/are: Available on stock Not available on stock Included In procurement plan Not included in procurement plan

FERDINAND S. REYES Budget Office ANA T. LAGRIMAS Supply Officer

CERTIFICATION/REQUISITIONER The requisitioner certifies on is/her honor that the above stated item/s is/are very essential to the operation of his unit/department and is/are urgently needed. Requested by: Approved: Signature Over Printed Name DR. NESTOR P. GALAROZA ATTY. MAR P. DE ASIS, PhD Designation Head, General Services Unit President Note: This purchase request shall be signed by the head of the requisitioning Office/Unit.