PURCHASE REQUEST

DepED, Albay Division

Agency

PR No. Date:
Department DepED, Albay Division SAI No. Date:
Section SGOD - School Health Section ORS No. Date:

Quantity Unit of Estimated Estimated

Item Description Stock No.
Measure Unit Cost Cost

( -  )
( -  )

TOTAL ( -  )
Purpose

Requested by: Recommending Approval:

Signature
Printed Name MARICHU V. PORTADES
Designation Administrative Officer IV - Supply Assistant Schools Division Superintendent
Date

CERTIFIED: Procurement included in the Annual Procurement Plan (APP) for 2017 per page number/s ___________,
Item No/s. _____________________________
Not included in the APP 2017, hence, Supplemental Procurement Program No. _________ s. 2017 is provided.

MARICHU V. PORTADES
BAC Secretariat Head-Designate
FUND SOURCE: End-user:
Approved:

BEBIANO I. SENTILLAS
Schools Division Superintendent
(Date: _____________________)