LGU Form No.

05 APPENDIX “F”
Rav 1992, CCA Clr #92-386
Republic of the Philippines

PURCHASE REQUEST
No. ______________ Date _________________

TO: General Services Officer/Local Treasurer: SK Treasurer, Paniangan

FROM: Department/Office Head (Requisitioner): SK Chairperson, Paniangan
Delivery/Shipment to: Sangguniang Kabataan of Barangay Paniangan Period of Delivery:
________________

Item Unit of Estimated

DESCRIPTION Qty. Estimated Cost
No. Issue Unit Cost
Procurement of Office Equipment and Facilities for SK use

1 Split-type Inverter Aircon, 2.5 hP, Media Brand Set 2 47,000.00 94,000.00
2 Split-type Inverter Aircon, 2h P, TCL Brand Set 1 42,000.00 42,000.00
3 3-in-1 Printer, Epson Brand Set 1 17,000.00 17,000.00
4 Desktop Computer Package set: Set 1 47,000.00 47,000.00
Desktop description and equipage:
1. Casing Intex IT-1705, 600 PSU
2. CPU SI200 Comet Lake G6400 Pentium G
3. HD SATA SSD, 480Gb, Sandisk SSD Plus
4. KB USB A4Tech KK-3330 w/Mouse Smart
5. MB SI200 MSI H510M Pro-E HDMI/VGA
6. DDRAM 4, 8Gb, 2666 Apacer
1 unit AVR Secure, 500W (3 x 220)
1 unit LED Monitor, Lenovo 66AE

GRAND TOTAL …………………………………………………………………….. ₱ 200,000.00

I certify that the need for the above-supplies is exceptionally urgent or absolutely indispensable to prevent imminent and
real danger to, or loss of, life or property.

I further certify that the said supplies are necessary for official use in connection with the following activity(s):

By: APPROVED:

SK Chairman
____________________________________ DANICCA A. CAMARA
Department/Office Head SK Chief Executive
Purchased from: ORDER
Item No. Qty. Unit Cost Total Cost
Number Date
Address: