Republic of the Philippines

Antipolo City Government

OFFICE OF PUBLIC SAFETY AND SECURITY
M.L. Quezon Street, Brgy. San Roque
Antipolo City 1870

ACKNOWLEDGEMENT RECEIPT OF
RETURNED EQUIPMENT
Received from _____________________ ___his/her ___________________________
particularly described as follows:

Type:______________________________________________________________________
_
Serial/Plate
No._______________________________________________________________

The said equipment was returned due to reason/s mentioned below:

-

For safekeeping while on approved work leave from ________ to

________
Defective for repair
Replaced Unit
Discharged from the service
Other reason (Please Indicate)

The above mentioned equipment was received on this office ____ day of
_____________ 20_____.

Prepared By:

Arjay O. Mayores
LOGISTICS & Supply OFFICER

Noted by:

Ma. Bella Teodora R. Yepes

Chief, Admin Div.