Agency:Account Code:

Name and Address of Requesting Agency: TAGULOD HIGH SCHOOL - JHS Agency Control No.:
Tagulod, Candaba, Pampanga
Agency: Department of Education
PS APR NO.:
AGENCY PROCUREMENT REQUEST
To: PROCUREMENT SERVICE
DBM-PROCUREMENT DEPOT _____October 31, 2019_______________
City of San Fernando, Pampanga (Date Prepared)

PLEASE CHECK ( / ) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S STATED 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 funds not sufficient ( ) reduce Quantity 9 0 BILL US ( ) CHARGE TO UNUTILIZED DEPOSIT, APR No. :__________Date :__________
( ) Please purchase f0or our agency non-common items. Attached herewith:
( ) Complete Specifications ( ) Obligation Request (ObR) ( ) Others, pls. specify ___________________________
( ) Certificate of Budget Allocation (CBA) ( ) Payment

This form shall be prepared for Requisition of Common-Use goods from the PS Depots & Sub-Depots; and for orders of
Consumables & Non-Common Use Supplies from the PS Main.
For PS Main-Common Use Supplies, please use Form 001A or Form 001 B
Please issue common use supplies/materials per PS price list no.
ITEM
NO. ITEM DESCRIPTION/SPECIFICATION QTY. UNIT UNIT PRICE AMOUNT
1 Bond paper long 3 reams
2 Bond paper A4 3 reams
3 Bond paper short 3 reams
4 Package tape 12 pieces
5 Double sided tape 15 pieces
6 Ballpen – black/green 12 pieces
7 Folder long white 100 pieces
8 Cartolina white 20 pieces
9 Correction tape 12 pieces
10 Doormat 20 pieces
11 Padlock 6 pieces

CONSTRUCTION MATERIALS FOR SCHOOL DRAINAGE

12 Hollow block 800 pieces
13 Cement 25 bags
14 Bakal 9mm 15 pieces
15 Bandai-bandai (bato) 1 truck
16 Alambre 1 kilogram

TOTAL AMOUNT
Requested by: APPROVED:

INOCENCIA C. MAÑAOL
ROSENDA D. SALE
HT-III / OIC
BAC-Chairman
School Head

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 Agency:Account Code:
Name and Address of Requesting Agency: TAGULOD HIGH SCHOOL - SHS Agency Control No.:
Tagulod, Candaba, Pampanga
Agency: Department of Education
PS APR NO.:
AGENCY PROCUREMENT REQUEST
To: PROCUREMENT SERVICE
DBM-PROCUREMENT DEPOT ______October 31, 2019_________
City of San Fernando, Pampanga (Date Prepared)

PLEASE CHECK ( / ) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S STATED 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 funds not sufficient ( ) reduce Quantity 9 0 BILL US ( ) CHARGE TO UNUTILIZED DEPOSIT, APR No. :__________Date :__________
( ) Please purchase f0or our agency non-common items. Attached herewith:
( ) Complete Specifications ( ) Obligation Request (ObR) ( ) Others, pls. specify ___________________________
( ) Certificate of Budget Allocation (CBA) ( ) Payment

This form shall be prepared for Requisition of Common-Use goods from the PS Depots & Sub-Depots; and for orders of
Consumables & Non-Common Use Supplies from the PS Main.
For PS Main-Common Use Supplies, please use Form 001A or Form 001 B
Please issue common use supplies/materials per PS price list no.
ITEM
NO. ITEM DESCRIPTION/SPECIFICATION QTY. UNIT UNIT PRICE AMOUNT
1 Bond paper short 2 reams
2 Bond paper long 2 reams
3 Bond paper A4 2 reams
4 Ballpen - black 3 pieces
5 Toilet bowl cleaner 2 bottles

TOTAL AMOUNT
Requested by: APPROVED:
 INOCENCIA C. MAÑAOL
ROSENDA D. SALE
HT-III / OIC
BAC-Chairman
School Head