Appendix 61

PURCHASE ORDER
_____________GUEGUESANGEN ES_________
Entity Name

Supplier : MARIGOLD STORE P.O. No. : ____________________________

Address : AB FERNANDEZ AVE. DAGUPAN CITY Date : 10-01-2021
TIN : 157-686-860-000 Mode of Procurement : SHOPPING
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 : ________________________
Stock/ Property No. Unit Description Quantity Unit Cost Amount

1 REAM BOOK PAPER A4 4 180.00 720.00

2 SET EPSON INK 003 1 1,180.00 1,180.00
3 REAM BOOK PAPER LONG 1 190.00 190.00
4 PCS. FOLDER LONG 21 4.00 84.00
5 BOTTLE EPSON INK OO3 (BLACK) 1 295.00 295.00
6 BOX FASTENER 1 31.00 31.00

(Total Amount in Words) TWO THOUSAND FIVE HUNDRED PESOS ONLY 2,500.00

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 on the undelivered item/s.

Conforme: Very truly yours,

__________________________ EMMA L. CARVAJAL

Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official
___________________________ HEAD TEACHER II
Date Designation

Fund Cluster : ___________________________________ ORS/BURS No. : ______________________

Funds Available : _________________________________ Date of the ORS/BURS: _______________
________________________________________Amount : ____________________________
Signature over Printed Name of Chief
Accountant/Head of Accounting Division/Unit
 Appendix 60

PURCHASE REQUEST

Entity Name: :
Office/Section GUEGUESANGEN ES Fund Cluster: 01110101
_____________ PR No.: ______________ Date:
Responsibility Center Code : ___________
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.

1 REAM BOOK PAPER A4 4 180.00 720.00

2 SET EPSON INK 003 1 1,180.00 1,180.00
3 REAM BOOK PAPER LONG 1 190.00 190.00
4 PCS. FOLDER LONG 21 4.00 84.00
5 BOTTLE EPSON INK OO3 (BLACK) 1 295.00 295.00
6 BOX FASTENER 1 31.00 31.00

Total 2,500.00
Purpose:
OKAY AS TO APP (SCHOOL BASED FEEDING PROGRAM)
_______________________________________________________________

Requested by: Approved by:

_____________________
Signature : _________________________
__
Printed Name : ARIANE E. DE LEON EMMA L. CARVAJAL
Designation : School SBFP Coordinator HEAD TEACHER II
Please write: OKAY AS TO APP
and please affix your full
signature. (school head)
 Appendix 62

INSPECTION AND ACCEPTANCE REPORT

Entity Name : ______GUEGUESANGEN E/S__________________ Fund Cluster : 01101101

Supplier : MARIGOLD STORE IAR No. : _______________

PO No./Date : 2020-10-01 Date : OCTOBER 01, 2021
Requisitioning Office/Dept. : _______________________________ Invoice No. : ____________
Responsibility Center Code : _______________________________ Date : _________________

Stock/
Description Unit Quantity
Property No.
1 BOOK PAPER A4 REAM 4
2 EPSON INK 003 SET 1
3 BOOK PAPER LONG REAM 1

4 FOLDER LONG PCS. 21

5 EPSON INK OO3 (BLACK) BOTTLE 1
6 FASTENER BOX 1

INSPECTION ACCEPTANCE
Date Inspected : ________________________ Date Received : _____________________

/ Inspected, verified and found in order as to quantity and / Complete

specifications
1.GRECIL A. VISPERAS-
Partial (pls. specify quantity)
2. ARLENE E. JUNATAS-
3. JAICY R. MACAALAY- ARIANE E. DE LEON
Name and Signature of Inspectorate Teams School SBFP Coordinator
 Appendix 62

01

Quantity
4
1
1
21
1
1

TANCE
________________

specify quantity)

DE LEON
Coordinator