Republic of the Philippines

Province of Eastern Samar

Municipality of Mercedes
BARANGAY 04

INSPECTION AND ACCEPTANCE REPORT

Supplier:
PO No.: ____________________ Date: ______________ Invoice No._______________ Date: ____________
Requisitioning Officer: _________________________________

Stock
Unit Description Quantity
No.

Date Inspected: ________________________ Date Received: ________________________

INSPECTION ACCEPTANCE

Inspected/ verified and found in order as Complete

to quality and specifications
Partial (pls. specify/quantify)

CHRISTOPHER A. IDA DEXTER I. BARCELON

Inspection Officer/ Inspection Committee/TWG Rep. End User