Appendix 64

REPORT OF SUPPLIES AND MATERIALS ISSUED

Entity Name: ___________________________________ Serial No. : _______________________

Fund Cluster: __________________________________ Date : ___________________________

To be filled up by the Supply and/or Property Division/Unit To be filled up by the Accounting Division/Unit

Responsibility Quantity
RIS No. Stock No. Item Unit Unit Cost Amount
Center Code Issued

Recapitulation: Recapitulation:

Stock No. Quantity Unit Cost Total Cost UACS Object Code

Posted by:
I hereby certify to the correctness of the above information.
_____________________________________________ __________________________ ______________
Signature over Printed Name of Supply and/or Signature over Printed Name of Date
Property Custodian Designated Accounting Staff

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