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 Pcs Kls

16x16 Floor Tiles/rough 16x16 Wall/ Smooth Tile Grout

For the restrooms for Basic Education Students-needed to provide support facilities and upgrade existing services.

50 100 4

P 80.00 80.00 80.00

P 4,000.00 8,000.00 320.00

Noted :

DR. BALTAZAR G. MARTIRES VP for Administration and Finance

Total: Fund for this purchase request is: Available Not Available P 12,320.00 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.