APR FORM revised May 2015 FORM NO.

002
AGENCY ACCT. CODE
NAME AND ADDRESS OF DOÑA AURORA NATIONAL HIGH SCHOOL
REQUESTING AGENCY AGENCY CONTROL NO.
TEL. NOS. (074) 422-3729
AGENCY PROCUREMENT REQUEST PS APR No.

To: THE PROCUREMENT SERVICE JULY 2, 2018

DBM Compound, RR Road Date Prepared
Cristobal St., Paco, Manila

PLEASE CHECK ( ∕ ) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW.

[ ] Please issue common-use supplies/materials per Price List No. ____________ dated ______________________
Mode of delivery: [ ] Pick-up (Fast Lane) [ ] Pick-up (Schedule) [ ] Delivery (Door-to-door)

In case fund is not sufficient: [ ] Reduce Quantity [ ] Bill Us [ ] Charge to Unutilized Deposit, APR No.: _______ Date: __________

[ ] Please purchase for our agency non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Others, pls. specify _____________________________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment _____________________________

This form shall be prepared for requisitions of Common-use goods from the PS Depots & Sub-Depots; and for orders of
Consumables & Non-Common Use Supplies from the PS Main
For PS Main-Common Use Supplies, please use Form 001 R or Form 001 B

ITEM No. ITEM AND DESCRIPTION / SPECIFICATION / STOCK No. QUANTITY UNIT UNIT PRICE
1 AIR FRESHENER, 280mL/can 6 can
2 ALCOHOL, 70%, ethyl, 500ml 10 bottle
3 CORRECTION TAPE, 6 meters(min), 1 piece 4 piece
4 MARKER, permanent, bullet type, black 5 piece
5 RUBBER BAND, 70mm (#18) 1 piece
6 TOILET TISSUE, 12 rolls per pack 5 pack
7 WRAPPING PAPER, kraft, 50 sheets per pack 1 pack
8 CUTTER KNIFE, heavy duty 5 piece
9 CARTOLINA, white, 20 pieces per pack 5 pack
10 CORRECTION PEN, 12ml 5 piece
11 MACHINE RIBBON TIME RECORDER for bundy clock 1 box
12 MARKER, permanent, chisel type, black, refillable 5 piece
13 OIL PASTEL, 12 colors/box 4 box
14 PAPER, Thermal, 210mm x 30m 1 roll
15 SPECIALTY BOARD, assorted, 10 pcs/pack 10 pack
16 TIME CARD, for Amano Bundy Clock,100 pieces 1 bundle
17 BROOM, stick (tingting) 12 piece
 18 CLEANER, toilet bowl and urinal, 900-1000ml 10 bottle
19 CLEANSER, scouring powder, 350grams/can 10 can
20 DETERGENT POWDER, all purpose, 1kilo/pouch 6 pouch
21 FLOOR WAX, Paste, red 10 can
22 RAG, all cotton, 32 pieces per kilo per bundle 5 bundle
23 SCOURING PAD, 5 pieces per pack 11 pack
24 JUTE SACK, 50kg capacity 20 piece
25 RUBBER GLOVES 5 pair
26 TOILET BOWL BRUSH, plastic, with handle 4 piece
27 TRASHBAG, black, 30 bags/pack 4 piece
28 BATTERY, size AA, alkaline, 2 pcs/pack 3 pack
29 BATTERY, size AAA, alkaline, 2 pcs/pack 3 pack
30 COMPACT FLUORESCENT LAMP, 18 watts 4 piece
31 TAPE, electrical 4 roll
32 STARTER, 40W 6 piece
33 Binding covers, A4, PVC, 100 pcs/pack 1 pack
34 Binding covers, Legal, PVC, 100 pcs/pack 1 pack
35 Sign pen, Pilot V5 0.5mm, blue 2 piece
36 Sign pen, Pilot V5 0.5mm, green 2 piece
37 Sign pen, Pilot V5 0.5mm, green 51 piece
38 Office Executive chair , High Back 1 unit
39 ELECTRIC FAN, stand type 1 unit
40 Assorted plants and garden ornaments 1 set

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME

FUNDS CERTIFIED AVAILABLE: APPROVED:
STOCKS REQUESTED ARE CERTIFIED TO
BE WITHIN APPROVED PROGRAM:

AGENCY PROP. / SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD / AUTHORIZED SIGNATURE

[ ] FUNDS DEPOSITED WITH PS [ ] ____________________ CHECK No. ____________________

IN THE AMOUNT OF: ___________________________________________________ ( ₱ _________________ ) ENCLOSED
 FORM NO. 002

2, 2018
Prepared

ED BELOW.

e: __________

ts; and for orders of

AMOUNT
ROVED:

THORIZED SIGNATURE