NAME AND ADDRESS E.

LOPEZ ELEMENTARY SCHOOL AGENCY

OF REQUESTING ACCT. CODE
Brgy. E. Lopez
AGENCY
Silay City AGENCY CONTROL NO.
AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM Compound, RR Road _____________________
Cristobal St., Paco, Manila
ACTION REQUESTED ON THE ITEMS LISTED BELOW

[ ] Please furnish with us the Price Estimate (for office equipment/furniture &supplementary items).
[ ] Please purchase for our agency/furniture/supplementary items per you Price Estimate
(PS RAD No. ______________ attached) dated _______________
[ ] Please issue common-use supplies/materials per price list as of __________________
[ ] Please issue Certificate of Price Reasonableness
[ ] Please furnish as with your latest/updated Price List
[ ] Other ( specify) _________________
IMPORTANT!! PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL COPY
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO. QTY. UNIT UNIT PRICE AMOUNT
No.

TOTAL
FUNDS CERTIFIED AVAILABLE APPROVED

STOCKS REQUESTED ARE CERTIFIED TO BE Accountant Authorized Agency Head

WITHIN THE APPROVED PROGRAM

STEPHEN J. REYES LUCY C. LINASAN

Supply Officer Accountant Authorized Agency Head
[ ] FUNDS DEPOSITED WITH PS [ ] _______________ CHECK No. _______________

IN THE AMOUNT OF ____________________________________(P___________) ENCLOSED

NAME AND E. LOPEZ ELEMENTARY SCHOOL AGENCY
ADDRESS OF ACCT. CODE
Brgy. E.Lopez
REQUESTING
AGENCY Silay City AGENCY CONTROL NO.
 AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM Compound, RR Road _____________________
Cristobal St., Paco, Manila
ACTION REQUESTED ON THE ITEMS LISTED BELOW

[ ] Please furnish with us the Price Estimate (for office equipment/furniture &supplementary items).
[ ] Please purchase for our agency/furniture/supplementary items per you Price Estimate
(PS RAD No. ______________ attached) dated _______________
[ ] Please issue common-use supplies/materials per price list as of __________________
[ ] Please issue Certificate of Price Reasonableness
[ ] Please furnish as with your latest/updated Price List
[ ] Other ( specify) _________________
IMPORTANT!! PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL COPY
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO. QTY. UNIT UNIT PRICE AMOUNT
No.

TOTAL
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED APPROVED
WITHIN THE APPROVED PROGRAM AVAILABLE

STEPHEN J. REYES LUCY C. LINASAN

Supply Officer Accountant Authorized Agency Head
[ ] FUNDS DEPOSITED WITH PS [ ] _______________ CHECK No. _______________

IN THE AMOUNT OF ____________________________________(P___________) ENCLOSED

NAME AND E. LOPEZ ES AGENCY

ADDRESS OF ACCT. CODE
Brgy. E.Lopez
REQUESTING
AGENCY Silay City AGENCY CONTROL NO.
 AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM Compound, RR Road _____________________
Cristobal St., Paco, Manila
ACTION REQUESTED ON THE ITEMS LISTED BELOW

[ ] Please furnish with us the Price Estimate (for office equipment/furniture &supplementary items).
[ ] Please purchase for our agency/furniture/supplementary items per you Price Estimate
(PS RAD No. ______________ attached) dated _______________
[ ] Please issue common-use supplies/materials per price list as of __________________
[ ] Please issue Certificate of Price Reasonableness
[ ] Please furnish as with your latest/updated Price List
[ ] Other ( specify) _________________
IMPORTANT!! PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL COPY
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO. QTY. UNIT UNIT PRICE AMOUNT
No.

TOTAL
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED APPROVED
WITHIN THE APPROVED PROGRAM AVAILABLE

STEPHEN J. REYES LUCY C. LINASAN

Supply Officer Accountant Authorized Agency Head
[ ] FUNDS DEPOSITED WITH PS [ ] _______________ CHECK No. _______________

IN THE AMOUNT OF ____________________________________(P___________) ENCLOSED