PURCHASE REQUEST

Entity Name: GABI NATIONAL HIGH SCHOOL (SHS) Fund Cluster: 01

Office/Section: PR No.: Date: January 24, 2023
Responsibility Center Code:
Stock/ Unit
Property Item Description Quantity Unit Cost Total Cost
No.
1 tablet Paracetamol 500 mg 50 3.90 195.00
tablet
2 caplet Phenylephrine HCl 50 4.00 200.00
Chlorphenamine
Maleate Paracetamol
500 mg caplet
3 tablet Loperamide HCl 2mg 50 3.00 150.00
capsule
4 tablet Cetirizine HCl 10 mg 50 2.50 125.00
tablet
5 tablet Aluminum HCl and 50 5.00 250.00
Magnesium HCl
Simeticone 178
mg/233 mg/30 mg
tablet
6 tablet Mefenamic Acid 500 50 2.50 125.00
tablet
7 tablet Hyoscine 20 8.00 160.00
butylbromide 10 mg
tablet
8 tablet Dicycloverine 20 2.50 50.00
hydrochloride 10 mg
9 tablet Domperidone 10 mg 20 4.00 80.00
tablet
10 bottle Methyl Salicylate 10 37.00 370.00
Camphor + Menthol
50 mL
11 bottle White Flower Oil 10 15.00 150.00
12 tube Terramycin Ointment 2 280.00 560.00
3.5 grams
13 Piece Cotton Rolls 25 mg 5 18.00 90.00
14 Piece Cotton Balls 25 mg 5 25.00 125.00
15 Piece Blood Pressure 1 1,850.00 1,850.00
Apparatus
16 Piece Pulse Oximeter 1 587.00 587.00

TOTAL 5, 067.00

Requested by: Approved by:

Signature:
Printed Name: CHIRLIE F. TOMPONG JANET M. GO
Designation: TEACHER II School Principal II