PURCHASE REQUISITION FORM

Complete the information and obtain approval below. Forward the completed and approved form to the Purchasing
Department. Forms that are not approved or incomplete will not be processed and shall be returned to the
requisitioner.

Date: May15, 2023

Requesitione Marynoll Casey

Site / Area : Tape and Reel, Amkor P1

BU1 X BU2 BU3 BU4

Business Unit : Reference: ____________________________

Description/s
(Please indicate complete details - Brand, Model, Part#, Size, Unit of
Item No. Quantity BUDGET Reason for Purchase (include attachments if needed)
Color, etc.) Measure

1 Epson L3210 ink (Balck) 3 bottles 168x3 = 504 Office and TNR production use

2 Epson L3210 ink (C, Y,M, BK) 2 SET 670x2=1340 Office and TNR production use

3 Packing Tape 2 rolls 58x2 = 116.00 TNR production use

4 Caster Wheel Universal Wheel 2 Inch Rotate 360 degrees​​Thread/Flat 15 pcs 15x25p= 525 Office and TNR production use

5 Bond Paper Short (8.5x11") 2 box 160x10 = 1600.00 TNR production use

6 Stapler 3 pcs. 364X3=1092 TNR production use ( replacement for broken stapler at production)

7 IPA 1 gallon 200 TNR production use

Total 5,029

To waive the Three-Vendor-Policy and Normal Lead Time, please specify reason for urgency.

Marynoll Casey Roberto Agawin / Dong Tan ELMER LAPEŃA

Requestor's Signature Business Unit Head / Dept. Manager President / COO

VENDOR CANVASS SHEET

(Purchasing to fil-up. Put N/A if not applicable)

Vendor 1 Vendor 2 Vendor 3 REMARKS

Item No.______

PRICE

Item No.______

PRICE

Item No.______

PRICE

Canvassed by: Noted by: _____________________ Approved by:

TD-01-PU-0032 Attachment 1 rev.AD

https://www.lazada.com.ph/products/caster-wheel-universal-wheel-2-inch-rotate-360-degrees-threadflatwith-bra
degrees-threadflatwith-brakefor-office-chair-i3237897892-s16286607880.html?channelLpJumpArgs=&clickTrackInfo=query%253Acaster%
kInfo=query%253Acaster%252Bwheel%252Bfor%252Boffice%252Bchair%253Bnid%253A3237897892%253Bsrc%253ALazadaMainSrp%25
%253ALazadaMainSrp%253Brn%253A78e765a270e0b8d3f10174c9f4e83967%253Bregion%253Aph%253Bsku%253A3237897892_PH%25
253A3237897892_PH%253Bprice%253A35%253Bclient%253Adesktop%253Bsupplier_id%253A500163798237%253Bpromotion_biz%253
%253Bpromotion_biz%253A%253Basc_category_id%253A22819%253Bitem_id%253A3237897892%253Bsku_id%253A16286607880%253B
%253A16286607880%253Bshop_id%253A1514890&fastshipping=0&freeshipping=0&fs_ab=2&fuse_fs=1&lang=en&location=Pampanga&
=en&location=Pampanga&price=35&priceCompare=&ratingscore=4.96969696969697&request_id=78e765a270e0b8d3f10174c9f4e83967
e0b8d3f10174c9f4e83967&review=33&sale=592&search=1&source=search&spm=a2o4l.searchlist.list.i40.30d23850zkM7UA&stock=1
23850zkM7UA&stock=1
 BUDGET MONITORING FORM
(To be attached on the Purchase Request (PR) Form)

ACCOUNT TYPE: COMPANY:

Freight Cost DDAPI (Device Dynamics)
Office Supplies MEI (Manchester)
Production Supplies TI (Testech Inc.)
Rentals
Repairs and Maintenance
Uniforms
Others (pls. specifify)

DATE (as of)_______________

ACTUAL
BUDGET BALANCE REMARKS
EXPENSES

BUDGET MONITORING FORM

(To be attached on the Purchase Request (PR) Form)

ACCOUNT TYPE: COMPANY:

Freight Cost DDAPI (Device Dynamics)
Office Supplies MEI (Manchester)
Production Supplies TI (Testech Inc.)
Rentals
Repairs and Maintenance
Uniforms
Others (pls. specifify)

DATE (as of)_______________

ACTUAL
BUDGET BALANCE REMARKS
EXPENSES