5/24/2018 APRBlank-slidepdf.com http://slidepdf.com/reader/full/apr-blank 1/6 NAME AND ADDRESS AGENCY OF REQUESTING ACCT. CODE AGENCY AGENCY CONTROL NO. PS APR No. To. THE PROCUREMENT SERVICE DBM Compound, RR Road Cristobal St., Paco Manila [ ] Please furnish with us the Price Estimate (for office equipment/furniture & supplementary items) [ ] Please purchase for our agency/furniture/supplementary items per you Price Estimate (PS RAD No. ________________attached) dated ___________________________ [ ] Please issue common-use supplies/materials per price list as of _________________________________ [ ] Please issue Certificate or Price Reasonableness [ ] Please furnish us with your latest/updated Price List [ ] Other (Specify) _______________________________________________________________ ITEM No. QTY UNIT UNIT PRICE AMOUNT 1 Data Folder Files, w/ finger ring 4 each 81.00 324.00 TOTAL 324.00 STOCKS REQUESTED ARE CERTIFIED TO BE APPROVED: WITHIN THE APPROVED PROGRAM: [ ] FUNDS DEPOSITED WITH PS [ ] _________________ CHECK No. _______________ IN THE AMOUNT OF_____________________________________________________ (P _________) ENCLOSED AGENCY PROCUREMENT REQUEST ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO. IMPORTANT!! PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL COPY MR. ENRIQUE S. PINONGAN Authorized Agency Head FUNDS CERTIFIED AVAILABLE AS PER ATTACHED EMPLOYEE PURCHASE ORDER PROV. OF NEG. OCC. Government Employee NOCHP
Personal PurchaseNAME AND ADDRESSPROV. OF NEG. OCC.AGENCYOF
REQUESTINGGovernment EmployeeACCT. CODEAGENCYNOCHPAGENCY CONTROL
NO.AGENCY PROCUREMENT REQUESTPS APR No.To. THE PROCUREMENT
SERVICEDBM Compound, RR RoadCristobal St., Paco Manila[ ] Please
furnish with us the Price Estimate (for office equipment/furniture
& supplementary items)[ ] Please purchase for our
agency/furniture/supplementary items per you Price Estimate(PS RAD
No. ________________attached) dated ___________________________[ ]
Please issue common-use supplies/materials per price list as of
_________________________________[ ] Please issue Certificate or
Price Reasonableness[ ] Please furnish us with your latest/updated
Price List[ ] Other (Specify)
_______________________________________________________________IMPORTANT!!
PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL
COPYITEM No.ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK
NO.QTYUNITUNIT PRICEAMOUNT1Data Folder Files, w/ finger
ring4each81.00324.00TOTAL324.00STOCKS REQUESTED ARE CERTIFIED TO
BEFUNDS CERTIFIED AVAILABLEAPPROVED:WITHIN THE APPROVED PROGRAM:AS
PER ATTACHED EMPLOYEE PURCHASE ORDERMR. ENRIQUE S.
PINONGANAuthorized Agency Head[ ] FUNDS DEPOSITED WITH PS [ ]
_________________ CHECK No. _______________IN THE AMOUNT
OF_____________________________________________________ (P
_________) ENCLOSED
APR BlankNAME AND ADDRESSAGENCYOF REQUESTINGACCT.
CODEAGENCYAGENCY CONTROL NO.AGENCY PROCUREMENT REQUESTPS APR No.To.
THE PROCUREMENT SERVICEDBM Compound, RR RoadCristobal St., Paco
ManilaACTION REQUESTED ON THE ITEM LISTED BELOW[ ] Please furnish
with us the Price Estimate (for office equipment/furniture &
supplementary items)[ ] Please purchase for our
agency/furniture/supplementary items per you Price Estimate(PS RAD
No. ________________attached) dated ___________________________[ ]
Please issue common-use supplies/materials per price list as of
_________________________________[ ] Please issue Certificate or
Price Reasonableness[ ] Please furnish us with your latest/updated
Price List[ ] Other (Specify)
_______________________________________________________________IMPORTANT!!
PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL
COPYITEM No.ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK
NO.QTYUNITUNIT PRICEAMOUNTTOTAL AMOUNTNOTE: ALL SIGNATURE MUST BE
OVER PRINTED NAME`STOCKS REQUESTED ARE CERTIFIED TO BEFUNDS
CERTIFIED AVAILABLEAPPROVED:WITHIN THE APPROVED PROGRAM:Supply
OfficerAccountantAuthorized Agency Head[ ] FUNDS DEPOSITED WITH PS
[ ] _________________ CHECK No. _______________IN THE AMOUNT
OF_____________________________________________________ (P
_________) ENCLOSED
