Annex 23

PURCHASE REQUEST
Barangay: .__________________ P.R. No.: _________________
City/Municipality: _____________ Date: ____________________
Province: ___________________
REQUISITION
Item Unit of Estimated Estimated
Qty Item description
Number Measurement Unit Cost Amount

Total Estimated Amount

Purpose:

Requested by: Approved:

_________________________ _________________________
Signature over Printed Name Signature over Printed Name
Requesting Officer Punong Barangay

_____________ _____________
Date Date
 Annex 23

PURCHASE REQUEST

INSTRUCTIONS

A. This form shall be prepared by the requesting person for the procurement of supplies,
property and equipment. It shall be the basis in preparing the PO. This form shall be
accomplished as follows:

1. Heading –
a. Barangay – name of barangay
b. City/Municipality – name of city/municipality of the barangay
c. Province – name of province of the barangay
d. P.R. No. – the PR shall be numbered as follows:
00 00 000
Serial number (one series each year)
Month
Year

e. Date – date of PR preparation

2. Item Number – code of the requested goods

3. Quantity – quantity of the goods requested
4. Unit of Measurement – unit of measure of the goods requested
5. Item Description – brief description of the goods
6. Estimated Unit Cost – estimated cost per unit of the goods being requested
7. Estimated Amount – estimated total amount of the goods requested
8. Total Estimated Amount – total estimated amount of all the goods specified in the
request
9. Purpose – a brief explanation on the purpose of the request
10. Requested by – name and signature of the person requesting the purchase of goods
11. Date – date of requisition
12. Approved by – signature of the Punong Barangay
13. Date – date of approval

B. The PR shall be distributed as follows:

Original – attachment to the Purchase Order

2nd copy – to the requesting officer
3rd copy – to the Barangay Treasurer