PURCHASE REQUISITION FORM

Requestor: Date: Series No. (To be filled by procurement) :

Jerson C. Ocera 04/27/2023
Department: To be used in (Project Name) :
Maintenance Department Ribshack Cebu and Ormoc
Specific Purpose or Usage:

Maintenance Budget for Ribshack Cebu and Ormoc

# Product/Description Qty. Unit Price Total Remarks
1 Passenger Fare (BCD-Cebu) 1 lot 250.00 250.00 back-and-forth
2 Vehicle Fare (BCD-Cebu) 1 lot 6,000.00 6,000.00 back-and-forth
3 Passenger Fare (Cebu-Ormoc) 3 lot 600.00 1,800.00 back-and-forth
4 Vehicle Fare (Cebu-Ormoc) 1 lot 12,000.00 12,000.00 back-and-forth
5 Misceleneous 1 lot 5,000.00 5,000.00 3 weeks
6 Diesel Fuel 1 lot 6,000.00 6,000.00 back-and-forth
7 0.00
8 0.00
9 0.00
10 0.00
11 0.00
12 0.00
13 0.00
14 0.00
15 0.00
16 0.00
17 0.00
18 0.00
19 0.00
20 0.00
21 0.00
22 0.00
23 0.00
24 0.00
TOTAL 31,050.00
Requestor: Approved by:

Signature Signature over Printed Name / Date