Date: August 18, 2021

REQUISITION AND ISSUE VOUCHER

Recipient/Barangay: SINUNUC

ITEM QUANTITY UNIT ARTICLES/PARTICULARS

NO.
1 6 bags Commercial rice (5 kilos/bag)
2 3 sets Assorted groceries (9 tins canned goods,

xxxxxxx (3 pcs noodles & 6 pcs coffee)

Note: 1 family or household = 2 bags rice &

1 set grocery

Purpose: Food assistance for families under LOCKDOWN due to COVID-19 at __________
as per Request Letter and Masterlist hereto attached.__________

CERTIFIED: All supplies received are in good condition and fit

Supplies requisitioned are necessary for human consumption.
and will be used solely for purpose/s herein stated.
RECEIVED BY:

_______________________________________
Name and Signature
Requesting Party/Representative
_______________________________________
Signature over Printed Name
_____________________________
Designation/Date

APPROVED BY:

RONALD S. CERVAS, MSW

SWO III/District Field Supervisor