PURCHASE REQUEST

SK of Barangay: Lunzuran PR No.: 2022- __-00__

City/Municipality: Zamboanga City Date:  ____________
Province: Zamboanga Del Sur
Unit of
Estimated Unit
Item No. Qty. Measuremen Item description Estimated Amount
Cost
t

1 3 1,250.00 3,750.00
Gallon
2 5 900.00 4,500.00
Box
Betadine 350.00 1,750.00
3 5 Pack
Surgical Gloves 750.00 2,250.00
4 3 Box Gauze Pad 1,000.00
5 3 Box 3,000.00
Terumo Syringe 3ml
6 10 575.00 5,750.00
Packs Terumo Syringe 5ml
7 20 490.00 9,800.00
Box Surgitech Plaster
8 5 Surgitech Chromic Suture
1165.75 5,828.75
Gallon
9 10 Alcohol 250.00 2,500.00
Pcs.
Lysol Liquid

x-x-x-x-x-x-x-x-x-x

Total Estimated Amount in words: THIRTY NINE THOUSAND ONE-HUNDRED TWENTY EIGHT & 75/100 PESOS ONLY. ₱ 39,128.75

Purpose:
Operation Tuli Program Medical Supplies.

Requested by: Approved by:

KIEMER TERRENCE R. SECHICO HON. BRYAN T. ARCILLAS

_______________________________
Signature over Printed Name Signature over Printed Name SK
Requesting SK Official Chairperson

Date Date