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DATE Sept 7 2016

BATCH NUMBER : TAM-16-331


REPLENISHMENT /RETURN FORM
PR /PO #
REPLENISHMENT RETURN
ORIGIN SPM PLDT TAMBO ORIGIN WWWCOMMARINDUQUE A3
Address PLDT TAMBO BLDG.226 QUIRINO AVE. TAMBO Address Bagong Silang Sta Cruz Marinduque 4902
Contact Person RENO A. RUFIN Contact Person LAWRENCE M. ROLLUQUI
Contact Number 9477063295 Contact Number 09212588477
DESTINATION WWWCOMMARINDUQUE A3 DESTINATION SPM PLDT TAMBO
Address Bagong Silang Sta Cruz Marinduque 4902 Address PLDT TAMBO BLDG.226 QUIRINO AVE. TAMBO
Contact Person LAWRENCE M. ROLLUQUI Contact Person RENO RUFIN
Contact Number 9212588477 iHelp Ticket Number Contact Number 9477063295 iHelp Ticket Number

Mode of Transacti Airway Bill Number Mode of Transaction Airway Bill Number
NO ITEM CODE DESCRIPTION QTY SO TYPE REMARKS ITEM CODE DESCRIPTION QTY SO TYPE REMARKS
1 M00132 CANOPY SM 1 Technical Support GOOD M00132 CANOPY SM 1 Technical Support DEFECTIVE
2 M00203 CANOPY POE 7 Technical Support GOOD M00203 CANOPY POE 7 Technical Support DEFECTIVE
3 M00127 FTP 0 Technical Support GOOD M00127 FTP 0 Technical Support DEFECTIVE
4 M00130 UTP 0 Technical Support GOOD M00130 UTP 0 Technical Support DEFECTIVE
5 M00218 SURGE 0 Technical Support GOOD M00218 SURGE 0 Technical Support DEFECTIVE
6 OUTDOOR W 0 Technical Support GOOD OUTDOOR WIMAX 0 Technical Support DEFECTIVE
7 PWM00001 INDOOR WIMAX 10 Technical Support GOOD PWM00001 INDOOR WIMAX 0 Technical Support DEFECTIVE
OUTDOOR WIMAX POE 0 Technical Support DEFECTIVE
M00385DF INDOOR WIMAX POE 0 Technical Support DEFECTIVE
M00384DF INDOOR LTE 0 Technical Support DEFECTIVE
OUTDOOR LTE 0 Technical Support DEFECTIVE
OUTDOOR LTE POE 0 Technical Support DEFECTIVE
M00384DF OUTDOOR LTE ROUTER 0 Technical Support DEFECTIVE
M00132 CANOPY SM 5 PULLOUT VPD / REL PULL OUT
PWM00001 WIMAX INDOOR 0 PULLOUT VPD / REL PULL OUT
WIMAX OUTDOOR 0 PULLOUT VPD / REL PULL OUT
OUTDOOR LTE 0 PULLOUT VPD / REL PULL OUT
OUTDOOR LTE ROUTER 0 PULLOUT VPD / REL PULL OUT

PREPARED BY APPROVED BY PREPARED BY 0.00 APPROVED BY

RENO A. RUFIN JAN JONARD BADILLO


SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

RECEIVED BY (courier/representative/requisitioner) RECEIVED BY (courier/representative/requisitioner)

RENO A. RUFIN
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
SO TYPE
Technical Support
Pullout IVPD
Pullout Relocation
Pullout VPD
Project/Recovered
0
EQUIPMENT DETAILS

NOTE TO BE FIILED OUT BY CONTRACTOR


DEPOT SMTYPE / BRAND NAME MSN / IMEI ESN / SU MAC SO SRN ACCOUNTNAME
PLDT Tambo MOTOROLA 0A003ED37796 3294840 1011064061 NERISA BRIONES DE SENA
PLDT Tambo MOTOROLA 6069GF9515 0A003EF7B318 3296823 1010973274 JOSINE PAR OBLIPIAS
PLDT Tambo MOTOROLA 6069JJ19HN 0A003ED36CCD 3296823 1010973274 CHITO PALATINO MALINAO
PLDT Tambo MOTOROLA 6069NY0GC9 0A003EDED49B 3295357 1011546222 ROMULO HUERTA MALVAR
PLDT Tambo MOTOROLA 606IMJE987 0A003EDB9687 3300634 1011273775 PRESCILA ROBLES ZULUETA
PLDT Tambo MOTOROLA 0A003E667394 3301362 1011652054 LAUREANO ACOPIO MACALINTAL JR
DATE Sept 7, 2016
BATCH NUMBER TAM-16-239

TAILS

CONTRACTOR REMARKS CONTRACTOR DATE TESTING TSQACODE


UNPLUGGED WWWCOMMARINDUQUE A3 August 26, 2016 Technical Support Canopy
Pullout VPD Canopy WWWCOMMARINDUQUE A3 August 25, 2016 Pullout VPD Canopy
Pullout VPD Canopy WWWCOMMARINDUQUE A3 August 27, 2016 Pullout VPD Canopy
Pullout VPD Canopy WWWCOMMARINDUQUE A3 August 27, 2016 Pullout VPD Canopy
Pullout VPD Canopy WWWCOMMARINDUQUE A3 September 3, 2016 Pullout VPD Canopy
Pullout VPD Canopy WWWCOMMARINDUQUE A3 September 7, 2016 Pullout VPD Canopy
BRAND SERIAL# SO SRN ACCOUNTNAME CONTRACTORREMARKS CONTRACTOR DATE TESTED TSQA CODE TESTING REMARKS

1 ASIA TREND UTP 3296823 1010973274 CHITO PALATINO MALINAO Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 27, 2016 POUTP POUTP
2 FULRUBELL SURGE 3296823 1010973274 CHITO PALATINO MALINAO Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 27, 2016 POSSS POSSS
3 FULRUBELL FTP 3296823 1010973274 CHITO PALATINO MALINAO Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 27, 2016 POFTP POFTP
4 Motorola CANOPY POE 3296823 1010973274 JOSINE PAR OBLIPIAS Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 25, 2016 POPOE POPOE
5 ASIA TREND UTP 3296823 1010973274 JOSINE PAR OBLIPIAS Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 25, 2016 POUTP POUTP
6 FULRUBELL SURGE 3296823 1010973274 JOSINE PAR OBLIPIAS Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 25, 2016 POSSS POSSS
7 FULRUBELL CANOPY POE 3290240 1011735290 MARIA LUISA LEAL NEPOMUCENO Unplugged/red ligth
WWWCOMMARINDUQUE A3
August 20, 2016 TSPOE Unplugged
8 FULRUBELL CANOPY POE 3292181 1011837815 PABLITO LUZ ALCOBER NO POWER WWWCOMMARINDUQUE A3
August 20, 2016 TSPOE NO POWER
9 FULRUBELL CANOPY POE 3293163 1011617779 NORRA MARCIANO NUNEZ Unplugged/red ligth
WWWCOMMARINDUQUE A3
August 20, 2016 TSPOE Unplugged
10 FULRUBELL CANOPY POE 3293176 1011161957 ANNA LISA REY DALUMPIENES Unplugged/red ligth
WWWCOMMARINDUQUE A3
August 20, 2016 TSPOE Unplugged
11 Motorola CANOPY POE 3296230 1010093278 AURORA LANOT PINON Unplugged/Intermittent
WWWCOMMARINDUQUE A3
August 20, 2016 TSPOE Unplugged
12 FULRUBELL CANOPY POE 3295357 1011546222 ROMULO HUERTA MALVAR Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 27, 2016 POPOE POPOE
13 FULRUBELL FTP 3295357 1011546222 ROMULO HUERTA MALVAR Pullout VPD Canopy
WWWCOMMARINDUQUE A3
August 27, 2016 POFTP POFTP
CARD BANK INC SHIELA MONTOYA
14
Motorola CANOPY POE 3299632 1010970910 NUNEZ NO POWER WWWCOMMARINDUQUE September
A3 3, 2016 TSPOE NO POWER
15 FULRUBELL CANOPY POE 3300732 1010143140 VINAH AREVALO RED Unplugged/red ligth
WWWCOMMARINDUQUE September
A3 3, 2016 TSPOE Unplugged
16 FULRUBELL CANOPY POE 3300634 1011273775 PRESCILA ROBLES ZULUETA Pullout VPD Canopy
WWWCOMMARINDUQUE September
A3 3, 2016 POPOE POPOE
17 ASIA TREND FTP 3300634 1011273775 PRESCILA ROBLES ZULUETA Pullout VPD Canopy
WWWCOMMARINDUQUE September
A3 3, 2016 POFTP POFTP
18 ASIA TREND WIMAX ID POE 3295852 4010097543 ROSAVILLA LACEDA PAR NO POWER WWWCOMMARINDUQUE September
A3 4, 2016 TSPOE NO POWER
19 ASIA TREND FTP 3301362 1011652054 LAUREANO ACOPIO MACALINTAL JR September 7, 2016
Pullout VPD Canopy WWWCOMMARINDUQUE A3 POFTP POFTP
FULRUBELL CANOPY POE 3301362 1011652054 LAUREANO ACOPIO MACALINTAL JR September 7, 2016
Pullout VPD Canopy WWWCOMMARINDUQUE A3 POPOE POPOE
ASIA TREND UTP 3301362 1011652054 LAUREANO ACOPIO MACALINTAL JR September 7, 2016
Pullout VPD Canopy WWWCOMMARINDUQUE A3 POUTP POUTP
FULRUBELL SURGE 3301362 1011652054 LAUREANO ACOPIO MACALINTAL JR September 7, 2016
Pullout VPD Canopy WWWCOMMARINDUQUE A3 POSSS POSSS