Annex 24

PURCHASE ORDER
Barangay: _____________________________________________ City/Municipality: _________________________________________
Tel. No.: ______________________________________________ Province: ________________________________________________

Supplier: ______________________________________________ PO No.: ____________________

Address: ______________________________________________ Date: ______________________
TIN: __________________________________________________ Mode of Procurement:

Bidding Negotiated Over the Counter

Gentlemen:
Please deliver to this office the following articles subject to the terms and conditions contained herein
Place of Delivery: Delivery Term:
Date of Delivery: Payment Term:
Unit Particulars Quantity Unit Cost Amount

(Total Amount in words)

In case of failure to make full delivery within the time specified above, a penalty of one-tenth (1/10)
of one percent for everyday of delay shall be imposed.
Very truly yours,
________________________
Punong Barangay
Conforme: Existence of Available Appropriations of
________________________ ________________________
(Signature over Printed Name) (Signature over Printed Name)
Supplier Chairman, Committee on Appropriations
_______________ _______________
Date Date
Annex 24
 Annex 24

PURCHASE ORDER (PO)

INSTRUCTIONS

A. This form in a letter format shall be accomplished as follows:

1. Barangay – name of the barangay

2. City/Municipality – name of the city/municipality of the barangay
3. Province – name of province of the barangay
4. Supplier/Address/TIN - name and address and TIN of the supplier
5. P.O. No. – the number assigned to the PO which shall be as follows:
00– 00 –0000

Serial number (one series for each year)

Month
Year

6. Date – date of the preparation of the PO

7. Mode of Procurement – mode of procurement such as public bidding, Procurement
Service, negotiated purchase, etc.
8. Place/Date of Delivery – place of delivery and definite date/s of delivery, if not
stated shall mean seven (7) days after the receipt of the PO by the supplier
9. Delivery Term – delivery term i.e. FOB destination, FOB shipping point.
10.Payment Term – specified period required when the delivered goods shall be paid
and discounts allowed such as 2/10, n/30
11.Unit – unit of measurement of the supplies and property (i.e. box, bottle, piece, etc.)
12. Particular – brief description of the supplies/goods ordered
13. Quantity – quantity of goods ordered
14. Unit Cost – cost per unit of the supplies/goods ordered
15. Amount – total amount of the goods ordered
16. Penalty Clause – penalty imposed by the agency in case of non-compliance with
the term
17.Conforme – signature over printed name of supplier or his representative signifying
his approval to the term set by the agency
18. Existence of Available Appropriations of: – shall be signed by the Chairman,
Committee on Appropriations with the amount specified

B. It shall be prepared in three copies distributed as follows:

Original– to the Supplier for conforme to the terms of the PO and

attachment tothe DV upon request for payment
2 Copy–
nd
retained by the Supply and Property Unit for file
3 Copy– COA Auditor
rd