APR FORM Revised 2015 FORM NO.

001
NAME AND BIOTO ELEMENTARY SCHOOL Agency Code
ADDRESS OF
REQUESTING
Prk. Riverside , Bioto, Tandag City Account Code
AGENCY Agency Cntrl No.

AGENCY PROCUREMENT REQUEST PS APR No.

To Procurement Service, DBM Sept. 29, 2020

Butuan City Date Prepared
PLEASE CHECK () APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED ON
[ ] 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/OR No.:___Date:___
In case item is not available: [ ] Issue CNAS [ ] Item for Replacement

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

[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Copy of APP [ ] Others, pls. specify________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment ___________________

[ ] Purchase of ITEMS ON SALE (IOS) in PS Main, Depots and Sub-Depots

IMPORTANT ! PLEASE SEE INSTRUCTIONS/CONDITIONS AT THE BACK OF ORIGINAL COPY

Item
Item & Description/Specifications Stock No. Qty Unit Unit Price Amount
No.
1 A4 Bond Paper 50 reams 245.00 12,250.00
2 Bond Paper legal 5 reams 260.00 1,300.00
3 Folder long 2 reams 480.00 960.00
4 Plastic Fastener 5 box 50.00 250.00
5 Digital Duplicator Ink 2 pc. 1,700.00 3,400.00
6 Digtal Duplicator Master 2 pc. 3,100.00 6,200.00
7 Brother Ink (TN 2380) 2 pc. 1,250.00 2,500.00
8 Cellophane Cover 20 meters 75.00 1,500.00
9 Thumbtacks 20 box 15.00 300.00
10 Epson Ink 664 ( black) 10 bot. 350.00 3,500.00
11 Epson Ink 664 ( Cyan) 4 bot. 350 1,400.00
12 Epson Ink 664 (Magenta) 4 bot. 350.00 1,400.00
13 Epson Ink 664 (Yellow) 6 bot. 350 2,100.00
14 Multi-Purpose Glue 130 ml. 5 bot. 75.00 375.00
15 Sign Pen 10 pcs. 30 300.00
16 Ballpen 10 pcs. 6 60.00
17 Printer ( Print Only) 2 unit 5,600.00 11,200.00
18 Correction Tape 10 pcs. 40 400.00

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TOTAL AMOUNT 49,395.00
SIGNATURE MUST BE OVER PRINTED NAME

STOCKS REQUESTED ARE CERTIFIED FUNDS CERTIFIED AVAILABLE: APPROVED:

TO BE WITHIN APPROVED PROGRAM

TEOFANES R. CONCHA SHERYL O. SITOY JUANITA S. CONCHA

SCHOOL PROPERTY/SUPPLY OFFICER ADAS - III SCHOOL HEAD

( ) FUNDS DEPOSITED WITH PS ( ) CHECK No.

the amount of (Php ) Enclosed