REQUISITION AND ISSUE SLIP

Province Of Batangas
Provincial Health Office

Division: Responsibility Center RIS No.: Date:

Office: Code: SAI No.: Date:
Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks
1 unit Acrylic Barrier / Sneeze Guard 25 25
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
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24
25
26
27
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29
30
31
32
Purpose: For the use of PROVINCIAL HEALTH OFFICE
Requested by: Approved by: Issued by: Received by:
Signature :
ROSVILINDA M. OZAETA, MD,
Printed Name : SHARON G. BENITEZ MPH, FPSMSI LAMBERTO ACOSTA JR SHARON G. BENITEZ
Designation : SUPPLY OFFICER1 PHO II ADMIN OFFICER III SUPPLY OFFICER1
Date :