APR FORM revised May 2015 FORM NO.

002
NAME AND ADDRESS OF Doña Arsenia Elementary School AGENCY ACCT. CODE
REQUESTING AGENCY Calingcuan, Tarlac City AGENCY CONTROL No.
TEL. NOS.
AGENCY PROCUREMENT REQUEST PS APR No.

To: PROCUREMENT SERVICE July 12,2021

DBM Compound, RR Road (Date Prepared)
Cristobal St., Paco, Manila

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.:___________Date:________

[ ] Please purchase for 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 requisitions 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 001 R or Form 001 B
ITEM
ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
No.
1 Philippine Flag 2 pc
2 Parchment Paper A4 10 pack
3 Worxboard A4 3 ream
4 1 1/2" ribbon 10 roll
5 photopaper 2 pack
6 Ceritificate Holder A4 150 pc
7 Long Reach Stapler 1 pc
8 USB Hub 1 pc
9 Headset 1 pc
10 6cm medal (bronze) 10 pc
11 3" ribbon 2 roll
12 Tape Dispenser 1 pc
13
14
15
16
17
18
19

TOTAL AMOUNT ₱ -
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE: APPROVED:
WITHIN APPROVED PROGRAM:

ROBERT M. CABIGTING ANALYN T. MANALANG SHERIE MAY L. OSONGCO/09688546255

AGENCY PROPERTY/SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

[ ] FUNDS DEPOSITED WITH PS [ ] ___________________ CHECK No. ____________________

IN THE AMOUNT OF: ____________________________________________________________ (P _____________________) ENCLOSED