Date: ____________________

REQUISITION AND ISSUE VOUCHER

Recipient/Barangay: _______________________

ITEM QUANTITY UNIT ARTICLES/PARTICULARS

NO.

Purpose:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
CERTIFIED: All supplies received are in good
Supplies requisitioned are condition and fit for human
necessary and will be used solely for purpose/s consumption.
herein stated.
RECEIVED BY:

______________________________________ ________________________________
_ Signature over Printed Name
Name and Signature
Requesting Party/Representative _____________________________
Designation/Date

APPROVED BY:

MA. SOCORRO A. ROJAS

City Social Welfare and Development Officer