ABSTRACT OF CANVASS

________________
Date

Name of Company: _____________________

Address: _____________________________

Name and Signature of Authorized Representative: ________________________

Sirs/Mesdames:

Please quote your best price for the following articles in the space indicated below. The Bureau of Quarantine, Department of Health,
reserves the right to accept, reject, waive defects in the canvass or bid.

Quantity Unit Items Unit Price Total Price

Total

Canvassed By:

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