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Document No.

:
MHSS-FM-DOIT-2018-002
DEVELOPMENT OFFICE FOR INFORMATION TECHNOLOGY Effective Date: April 27, 2018
BORROWING FORM FOR TEACHING AND NON - TEACHING Last Edit: November 8, 2022

Date: ____________

Reason / Purpose: ________________________________________________________________________________________

Number of day/s Item will use: ________________ Date/Time (From: _______________ To: __________________)

List of item/s (Use a separate sheet if needed)


TIME
QTY. ITEM/S Out In REMARKS

Borrower Approved By: Noted By:

Signature Over Printed Name / Date Nathaniel J. Benjamin / Date Arvind Troi B. De Vera / Date
Administrative Officer IT Support

Borrower’s Commitment: I will be accountable for any damage incurred in the equipment and will return the equipment promptly and in the
same working condition it was borrowed.

Document No.:
MHSS-FM-DOIT-2018-002
DEVELOPMENT OFFICE FOR INFORMATION TECHNOLOGY
Effective Date: April 27, 2018
BORROWING FORM FOR TEACHING AND NON - TEACHING
Last Edit: November 8, 2022

Date: ____________

Reason / Purpose: ________________________________________________________________________________________

Number of day/s Item will use: ________________ Date/Time (From: _______________ To: __________________)

List of item/s (Use a separate sheet if needed)


TIME
QTY. ITEM/S Out In REMARKS

Borrower Approved By: Noted By:

Signature Over Printed Name / Date Nathaniel J. Benjamin / Date Arvind Troi B. De Vera / Date
Administrative Officer IT Support

Borrower’s Commitment: I will be accountable for any damage incurred in the equipment and will return the equipment promptly and in the
same working condition it was borrowed.

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