APR Form Revised March 2007

NAME AND ADDRESS: MAESTRO CORNELIO S. MINOR NATIONAL HIGH SCHOOL AGENCY
OF REQUESTING: DIPLO, KUMALARANG, ZAMBOANGA DEL SUR ACCT. CODE
AGENCY: DEPARTMENT OF EDUCATION AGENCY CONTROL No.
TEL. NOS.:
PS APR No.
AGENCY PROCUREMENT REQUEST

To: THE PROCUREMENT SERVICE September 25, 2019

Department of Budget and Management (Date Prepared)
Zamboanga Sibugay Province

PLEASE CHECK (⁄) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

[ ] Please issue common-use supplies/materials per Price List No. _____________________________ dated____________
Mode of delivery: [ ] Pick-up (Fast Lane) [ √ ] Pick-up (Schedule) [ ] Delivery (door-to-door)

In case fund is not sufficient: [ ] Reduce Quantity [ ] Bill Us [ ] Charge to Unutilized Deposit, APR No. ___________

[ ] Please purchase for our agency non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR)
[ ] Certificate of Budget Allocation (CBA) [ ] Payment

IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK HEREOF

ITEM No. ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY Unit
1 8x13 Multi-colored Paper 22 ream
2 Wall fan 2 pcs.
3 Long Brown Envelope 31 pcs.
4 Big Notebooks 50 lvs. 60 pcs.
5 Long Folders 10 pcs.
6 Glass Jalousie 18 spands
7 Paint Thinner 2 cans
8 Roof Paint 7 gal
9 #4 Paint Brush 4 pcs.
10 Roller Brush 1 pc.
11 Floor Map 1 pc.
12 Rust Converter 1 pc.
13 Primer 5 gal
14 Flat Bars 2x1/8 15 length 20 pcs.
15 Welding Rod 1 kl.
16 Mobile cards 40 cards
xxxxxxxxxxxxxxx
Total AMOUNT P
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED by: FUNDS CERTIFIED AVAILABLE APPROVED:

JUDITH S. RESILOSA RUBY L. LOQUERO

Supply Officer Designate Bookkeeper

[ ] FUNDS DEPOSITED WITH PS [ ] _____________________CHECK No. __________________

IN THE AMOUNT OF: ____________________________________________________________________ (P_________
GENCY CONTROL No.

September 25, 2019

(Date Prepared)

__________ dated________________________
] Delivery (door-to-door)

d Deposit, APR No. _______________ Date ______

[ ] Others, pls. specify_____________

_____________________________

NS AT THE BACK HEREOF

Unit Price AMOUNT

Total AMOUNT P
NTED NAME

JULIET G. HINOG
SSP1

____________
________________ (P______________) ENCLOSED