Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 01/17/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SKU 307 Liters Diesel 30.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/3/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SKR 331 Liters Diesel 40.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SJS 247 Liters Diesel 40.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SKC 224 Liters Gasoline 40.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 REQUISITION AND ISSUE SLIP
QUEZON CITY GOVERNMENT
LGU

Division: __________ Responsibility Center RIS No.: Date:

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

AF51 1 Requested by:

ISAGANI PANGANTIJON JR.

SK Chairman

Noted by:
CERTIFIED CORRECT AS TO BALANCE
AND REMITTANCE NENITA C. VALDEZ
Brgy. Chairman

ARVIN PHILIP M. GOTLADERA

Head, Fiscal Verification Section
Administrative Division

Recommending Approval:

CARMELITA P. DAR

Acting Chief Administrative Officer

Purpose:

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: BYRON VENTORILLO RUBY ROSA G. GUEVARRA

Designation: SK TREASURER OIC-City Treasurer

Date:
Issuance
Remarks

Requested by:

ISAGANI PANGANTIJON JR.

SK Chairman

Noted by:

NENITA C. VALDEZ
Brgy. Chairman

Received By:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date:

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SH 3063 Liters Gasoline

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SH 3063 Liters Gasoline 8.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

SH 3063 Liters Gasoline 5.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

MIO VIOLET Liters Gasoline 8.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/5/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

MIO BLACK Liters Gasoline 8.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

MIO Liters Gasoline 8.00

BLACK 2

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

MIO WHITE Liters Gasoline 8.00

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

Toyota Liters Diesel 40.00

Fortuner

SAA 3665

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date: 1/1/19

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

Toyota Liters Diesel 40.00

Innova

SKM 707

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date:
 Annex 33

REQUISITION AND ISSUE SLIP

BARANGAY KALIGAYAHAN
LGU

Division: __________ Responsibility Center RIS No.: Date:

Office: ___________ Code: __________________________ SAI No.: Date:

Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks

PT 0675 Liters Diesel

Purpose: For the purchase of Gas & Oil to keep the Brgy. Motor Vehicle in good
running condition.

Requested By: Approved By: Issued By: Received By:

Signature:
Printed Name: ALFREDO S. ROXAS

Designation: BRGY. CHAIRMAN

Date: