Angelo G. Cudal Jr.

BSTM – 1A

Goods Receiving Form

Receiving Record

Received From: Angela G. Cudal

Address: Zone 5 Maliwalo Tarlac City

Date: January 18, 2021

Quantity Item reference Description

Number
1 1 pack Milo The plastic packaging is good
2 2 Packs Sugar The plastic packaging is good
3 1 Bottle Ketchup The bottle is good
4 1 bottle Silver Swan Soy The plastic bottle is new, safe and clean
Sauce
5 1 bottle Datu Puti Patis The bottle is new, safe and clean
6 1 bottle Silver Swan Vinegar The bottle is new, safe and clean
7 2 cans 555 Sardines The can is good
8 2 cans Argentina Meat loaf 1 can is good but the other one was crumpled and
looks old
9 2 cans Argentina Tuna The can is good
10 12 pcs. Magic Sarap The plastic packaging is clean and safe
11 6 pcs. Sinigang Mix The plastic packaging is clean and safe
12 12 pcs. Knor Cubes The plastic packaging is clean, and safe
13 1 can Alaska Evaporada The can is new, clean and safe
14 1 can Alaska Condensada The can is new, clean and safe

Number of Total Weight Received by Checked by

packages
1 box 7. 321 Kg Angela G. Cudal Angelo G. Cudal
Goods Rejected Form

Date: January 18, 2021

TO: FROM:
Dalisay Grocery One Maliwalo BLDG. Maliwalo Angelo G. Cudal Jr.
Tarlac City

We are hereby RETURNING the above goods on account of defects in the goods stated as follows:

REF # QTY ITEM DAMAGE PRICE

DESCRIPTION DESCRIPTION
0000000280405 1 can Meat loaf The can was ₱ 36.95
crumpled and its
look old
TOTAL: ₱ 36.95

Credit for the goods returned in hereby claimed and demanded. Such a claim does not limit our right to
further credits or damages if additional credits or damages are discovered to be due or additional
returns are made. Settlement with or release to you does not waive any rights against any other party.
All rights are reserved cumulatively and not exclusively. Nothing contained herein shall after any other
documentation issued by us unless specifically stated so.

This noticed is made under the [CODE] (if applicable) and all other applicable laws.

RETURNING PARTY

By: Angelo G. Cudal Jr.