Acknowledgement Receipts

LIQUIDATION FORM 001 : REV 2017
REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION
SCHOOLS DIVISION OF ILOILO
Luna St. La Paz, Iloilo City
PURCHASE REQUEST
STO DOMINGO ELEMENTARY SCHOOL

Procuring Entity
Department ELEMENTARY - NON IMPLEMENTING UNIT PR No.

District Date
ESTIMATED Total Estimated

Item No UNIT ITEM DESCRIPTION QUANTITY
UNIT COST Cost
TOTAL
Purpose
Requested by Approved
Signature
Printed
Name
Designation Procurement Officer/Property Custodian School Administrator
Date

STO DOMINGO ELEMENTARY SCHOOL
REQUEST FOR QUOTATION
Please quote your lowest price on the item/s listed below stating the shortest time of
delivery and submit your quotation duly signed by your representative.
BAC CHAIRMAN / SCHOOL HEAD

Canvassed by
Signature over Printed Name
Item No Description Qty Unit Bidders Quote Total Cost

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL - -
After having carefully read and accepted your general conditions, I/We quote you on the items listed above
Signature Over Printed Name of the Supplier
Tel No. / Cp No. / Contact No of the Supplier

Date
ABSTRACT OF BIDS
NAME OF PROJECT PROJECT NO.

SOURCE OF FUND
LOCATION OF PROJECT
BIDDER 1 BIDDER 2 BIDDER 3
Inspected & Certified Correct
BAC CHAIRMAN
Signature over printed name
BAC MEMBER BAC MEMBER

Signature over printed name Signature over printed name
PURCHASE ORDER
(Name of School)
Procuring Entity
Supplier PO No.
Address Date
TIN Mode of Procurement
Gentlemen
Please furnish this Office the following articles subject to the terms and conditions contained herein
Place of Delivery Delivery Term
Date of Delivery Payment Term
Item No Unit Description Quantity Unit Cost Total Cost

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL AMOUNT
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10)
of one percent for every day of delay shall be imposed.
Very truly yours,
Conforme School Administrator
Signature Over Printed Name
Date
Funds Available
In reference with PR No.
________________
______________________________
Administrative Assistant III
PROGRAM OF WORKS
PROJECT TITLE PROJECT LOCATION

SOURCE OF FUND PROJECT NUMBER
SCOPE OF WORK
Quantity Unit Item Description Estimated Cost Total
TOTAL COST OF MATERIALS

COST OF LABOR
TOTAL PROJECT COST
Prepared by
______________________________________
School Administrator
Certified Correct
MEMBERS OF THE INSPECTORATE TEAM
Name Name Name


INSPECTION & ACCEPTANCE REPORT
SUPPLIER IAR NO/ DATE

PO NO/DATE OR NO/DATE
REQUESTED BY
REQ. OFFICE
ITEM NO UNIT DESCRIPTION QUANITY UNIT COST

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
INSPECTION ACCEPTANCE
DATE DATE
Inspected, verified and found ok as to Complete
quality and specifications Partial (pls specify)
Members of the Inspectorate Team
Property Custodian
PRE & POST INSPECTION REPORT
DATE
PRE REPAIR INSPECTION REPORT
FINDINGS
RECOMMENDATION
SCOPE OF WORK TO BE PERFORMED
DATE
POST REPAIR INSPECTION REPORT
FINDINGS
Prepared by
School Administrator
Certified Correct
MEMBERS OF THE INSPECTORATE TEAM
Name Name Name


ACCOMPLISHMENT REPORT
Name of School School ID
School Address Project Title
Location of Project Percentage of Completion
Source of Fund Total Cost of Materials
Date Started / Date Finished Labor Cost
Specified Scope of Work
Certification
I hereby certify that the above filled out form is correct and reviewed carefully
______________________________________
Pakyaw Contractor/Worker
______________________________________
Date
Inspected and Certified Correct Noted
Members of the Inspectorate Team
Signature over Printed Name School Administrator

Repblic of the Philippines
Region VI - Western Visayas
Schools Division of Iloilo
ALCARDE GUSTILO MEMORIAL NATIONAL HIGH SCHOOL
Alibunan, Calinog, Iloilo
Date
AR No.
ACKNOWLEDGEMENT RECEIPT
Received from ALCARDE GUSTILO MNHS - SENIOR HIGH SCHOOL

of Brgy. Alibunan, Calinog, Iloilo
the amount
as payment for the following:
DESCRIPTION TOTAL
as payment for TRANSPORTATION EXPENSE from
to
Vehicle Plate No.:
Contact No.:
TOTAL
PAYEE
ADDRESS
Date
AR No.

of Brgy. Alibunan, Calinog, Iloilo
the amount Eight Hundred Ten Pesos Only (P 810.00)
DESCRIPTION TOTAL
as payment for the transportaion/services rendered during the

Seminar in Tagisan ng Talino sa Filipino 810.00
to
CHERYL D. MALQUERIDO
(Name of Person)
with the community tax certificate number
issued at
on
TOTAL 810.00
PAYEE CHERYL D. MALQUERIDO
ADDRESS Badu, Calinog, Iloilo
Date
AR No.
Received from ALCARDE GUSTILO MNHS - JUNIOR HIGH SCHOOL

of Alibunan, Calinog, Iloilo the amount
DESCRIPTION TOTAL
as payment for the service/s rendered for the
to
(Name of Person)
with the community tax certificate number
issued at
on
TOTAL
PAYEE
ADDRESS
Date
AR No.

of Alibunan, Calinog, Iloilo the amount
QTY. UNIT DESCRIPTION PRICE TOTAL
TOTAL
PAYEE MARJORIE LABADAN
ADDRESS Alibunan, Calinog, Iloilo

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LIQUIDATION FORM 001 : REV 2017

REPUBLIC OF THE PHILIPPINES

STO DOMINGO ELEMENTARY SCHOOL

Department ELEMENTARY - NON IMPLEMENTING UNIT PR No.

ESTIMATED Total Estimated

REPUBLIC OF THE PHILIPPINES

STO DOMINGO ELEMENTARY SCHOOL

REQUEST FOR QUOTATION

BAC CHAIRMAN / SCHOOL HEAD

Signature over Printed Name

Item No Description Qty Unit Bidders Quote Total Cost

Signature Over Printed Name of the Supplier

Tel No. / Cp No. / Contact No of the Supplier

NAME OF PROJECT PROJECT NO.

BIDDER 1 BIDDER 2 BIDDER 3

Inspected & Certified Correct

BAC MEMBER BAC MEMBER

Item No Unit Description Quantity Unit Cost Total Cost

Conforme School Administrator

Signature Over Printed Name

PROJECT TITLE PROJECT LOCATION

Quantity Unit Item Description Estimated Cost Total

TOTAL COST OF MATERIALS

Name Name Name

REPUBLIC OF THE PHILIPPINES

INSPECTION & ACCEPTANCE REPORT

SUPPLIER IAR NO/ DATE

ITEM NO UNIT DESCRIPTION QUANITY UNIT COST

Members of the Inspectorate Team

PRE & POST INSPECTION REPORT

SCOPE OF WORK TO BE PERFORMED

Name Name Name

REPUBLIC OF THE PHILIPPINES

School Address Project Title

Location of Project Percentage of Completion

Source of Fund Total Cost of Materials

Date Started / Date Finished Labor Cost

Specified Scope of Work

Signature over Printed Name

Signature over Printed Name School Administrator

Signature over Printed Name

Received from ALCARDE GUSTILO MNHS - SENIOR HIGH SCHOOL

as payment for TRANSPORTATION EXPENSE from

Vehicle Plate No.:

Received from ALCARDE GUSTILO MNHS - SENIOR HIGH SCHOOL

as payment for the transportaion/services rendered during the

with the community tax certificate number

Received from ALCARDE GUSTILO MNHS - JUNIOR HIGH SCHOOL

as payment for the following:

as payment for the service/s rendered for the

with the community tax certificate number

Received from ALCARDE GUSTILO MNHS - SENIOR HIGH SCHOOL

as payment for the following:

QTY. UNIT DESCRIPTION PRICE TOTAL

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