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REQUISITION AND ISSUE SLIP

SK of Barangay: Lunzuran RIS No.: 2022-__-00__


City/Municipality:Zamboanga Date:
Province:Zamboanga del Sur
Requisition Issue
Stock No. Unit of
Measurement Item Description Quantity Quantity Remarks

1 Gallon Betadine 3 3
2 Box Surgical Gloves 5 5
3 Pack Gauze Pad 5 5
4 Box Terumo Syringe 3ml 3 3
5 Box Terumo Syringe 5ml 3 3
6 Packs Surgitech Plaster 10 10
7 Box Surgitech Chromic Suture 20 20
8 Gallon Alcohol 5 5
Lysol Liquid
9 Pcs. 10 10

Purpose: Operation Tuli Program Medical Supplies.

Requested by: Approved by: Issued by: Received by:

Signature

Printed
Name Kiemer Terrence R. Sechico Bryan T. Arcillas Kiemer Terrence R. Sechico Arsiman M. Siddung
Designatio
n Requisitioner SK Chairman SK Treasurer Recipient
Date

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