Various Forms

Appendix 5Republic of the Philippines

DEPARTMENT OF EDUCATIONRegion I

PANGASINAN DIVISION ILingayen

QUOTATION FORM

Package : ___________________ PR. NO.Supplier : ___________________Address : ___________________Tel. No. : ___________________Name of Authorized Representative : ___________________

Quantity Agency Specifications Bidders Specifications Total Amount

______________________________Printed Name & Signature

______________________________Position / Designation

______________________________Canvasser

This form to be submittednot later than : ___________________ Bid Opening: : ___________________ Note: for : ___________________

In accordance with your invitation for Sealed Quotations for the above mentioned package and subject to all conditions and requirement thereof, we / I will perform the above service at a total cost in Philippine Pesos of _________________________________________ down as follows: (P ______________________) broken down as follows:

Unit Cost

conformity with the specifications and at the price/s we have quoted above. We understand that you are not bound to accept the lowest or any quotation that you received.Date this _____________ day of _____________________________________, __________________________.




STOCK CARD

Item: Description: Stock No.

Date Reference Receipt Qty.

Issuance Balance

AmountQty. Qty. Qty.Region / Division




PROPERTY CARD

Property , Plant and Equipment:Property Number:

Description:

Date ReferenceReceipt Transfers / Disposal

Balance Qty.Qty. Qty. Office / Officer




ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

QUANTITY UNIT DESCRIPTION (Serial No. if any) PROPERTY NO.

Received By: Received From:

_____________________________ _____________________________ Signature Over Printed Name Signature Over Printed Name _____________________________ _____________________________ Position / Office Position / Office _____________________________ _____________________________ Date Date




INVOICE -RECEIPT FOR PROPERTY

QTY. NAME AND DESCRIPTION

TOTAL AMOUNT:INVOICE RECEIPT

I certify that I have this ____________ day I certify that I have this ________ dayof ________________________________, invoiced to of _________________________, received frm._____________________, ______________________ ________________, __________ (Designation)

(Designation)the above listed articles, property of __________________________________________________________ ______________________________________ (Name of bureau or office) (Name of bureau or office)

TEODOSIO C. SANGIL, JR.(Signature of Invoicing Accountable Officer) (Signature of Receiving Accountable Officer

Transfer of property from DepEd Central Office to _____________ authorized by _______________________ Secretary ARMIN LUISTRO _____________

UNIT/S

DATE OF PURCHASED

PROPERTY NUMBER

CLASSIFICATION NUMBER

UNIT VALUE

TOTAL VALUE

Undersecretary(Title) (Title)

Appendix 15

REPORT OF SUPPLIES AND MATERIALS ISSUED

_______________________________________________Agency

Date: ____________ No.: _____________

To be filled up in the Supply and Property Unit To be filled up in the Accounting Unit

RIS No. STOCK No. ITEM UNIT AMOUNT

Recapitulation: Recapitulation:

Stock No. Quantity Unit Cost Total Cost Account Code

I hereby certify to the corrections of the above information Posted by/date:

_____________________________________ ______________________Supply Officer Accounting Clerk

RESPONSIBILITY CENTER CODE

QTY ISSUED

UNIT COST

REPORT ON THE PHYSICAL COUNT OF INVENTORIES____________________________________________________________________

(Type of Inventory Item)As of _______________________________

For which __________________, ____________________, __________________ is accountable, having assumed such accountability on ____________ (Name of Accountable Officer) (Official Designation) (Agency/ Office) (Date of Assumption)

ARTICLE DESCRIPTIONSTOCK

NUMBERUNIT

VALUEBALANCE PER

CARD (Quantity)ON HAND PER

COUNT (Quantity)

Appendix 16REPORT ON THE PHYSICAL COUNT OF INVENTORIES

____________________________________________________________________(Type of Inventory Item)

As of _______________________________For which __________________, ____________________, __________________ is accountable, having assumed such accountability on ____________

(Name of Accountable Officer) (Official Designation) (Agency/ Office) (Date of Assumption)

SHORTAGE/OVERAGEREMARKSQUANTITY VALUE

Appendix 17

DEPARTMENT OF EDUCATIONPHYSICAL INVENTORY FOR PROPERTY, PLANT AND EQUIPMENT

SCHOOL:

CODE DESCRIPTION CODE DESCRIPTION CODE DESCRIPTION COST(8) (16) (6) (16) (6) (16) (25) (55) (8) (9) (15) (10) (11) (30)

CERTIFIED CORRECT:

Principal/SchoolHead

PROPERTY#

DESCRIPTION (INCLUDE SERIAL

NO. IF AVAILABLE)ESTIMATED LIFE YEARS

DATE ACQUIRED

ACCOUNTABLE OFFICE

(RC CODE)DEPRECIABLE

(1/0)

Appendix 18

Republic of the PhilippinesDEPARTMENT OF EDUCATION

Region IPANGASINAN DIVISION I

Lingayen

PRE-REPAIR INSPECTION REPORT

Item / Description: _____________________________________________________________Property Number: _______________________ Property Accountability Receipt: ____________Acquisiiton Cost: ______________________ Acquisition Date: _________________________Nature and Scope of Last Repair, if any: ____________________________________________ ___________________________________________________________________________Complaints / Defects:

Parts / Components to be Repaired / Replaced: ________________________________________ _____________________________________________________________________________FINDINGS / OBSERVATIONS: ______________________________________________________

Property Inspector / Date

POST - REPAIR INSPECTION REPORT

Job Order No. ________ Amount: __________ Invoice No. : __________ Amount: _________FINDINGS/COMMENTS: ___________________________________________________________

Property Inspector / Date

Appendix 19

WASTE MATERIALS REPORT

Republic of the PhilippinesDEPARTMENT OF EDUCATION

Region IPANGASINAN DIVISION I

LingayenPLACE OF STORAGE: DATE:

ITEMS FOR DISPOSAL:

ITEMS QUANTITY UNIT DECSRIPTIONRECORDS OF SALES

O.R. NO. AMOUNT

CERTIFIED CORRECT: DISPOSAL APPROVED:

____________________________ ____________________________________________Chief, Property Division

CERTIFICATE OF INSPECTION I hereby certify that the property enumerated above was disposed of as follows:

Item _________ DestroyedItem _________ Sold at private saleItem _________ Sold at public auctionItem _________ Transferred without cost to

PROPERTY INSPECTOR: (NAME & SIGNATURE) WITNESS TO DISPOSITION:

Appendix 19INVENTORY AND INSPECTION REPORT OF UNSERVICEABLE PROPERTY

As of __________________

(Agency) (Name of Accountable Officer (Designation)

INVENTORY INSPECTION REPORTArticles Quantity

Disposition Appraisal Amount

(9) (10) (11) (12) (13) (14) (15) (16)(1) (2) (3) (4) (5) (6) (7) (8)

Requested by: Request for Inspection Approved by: Requested by:

________________________________ ________________________________(Signature of Accountable Officer) (Name & Signature) ________________________________ ___________________________

( Name and Signature of Inspector) ( Name and Signature of Witness)

________________________________ ________________________________

(Designation of Accountable Officer) (Designation)

Unit Cost

Total Cost

Property No.

Date Acquired

No. of Years in Service

Accumulated Depreciaiton Official

Receipt No.

I HEREBY request inspection, and disposition pursuant to Section 79 of PD 1445, of the Property enumerated above.

I CERTIFY that I have inspected each and every article enumerated in this report and that the disposition made thereof was, in my judgement, the best for the public interest.

I CERTIFY that I have witnessed the disposition of the article enumerated on this report this ___ day of ______.

Appendix 21aRepublic of the Philippines



Report on Deliveries (Textbook / Desk and Armchairs / Equipment) Received Procured by Central Office/DBM Procurement Service

Note:Name of School: This form shall be used by theAddress of Shool: recipient school in preparing theDivision/ Region: report on deliveries

DATE RECEIVED SUPPLIER QUANTITY DECSRIPTION D.R. NO. UNIT COST TOTAL COST REMARKS

Prepared by: Certified Correct:

Property Costudian Principal

Date Date

Appendix 21bRepublic of the Philippines



CONSOLIDATED REPORT ON DELIVERIES OF_____________FOR THE PERIOD _______________

DepEd Region Office: _____________Division of ____________________

SUPPLIERQUANTITY

DECSRIPTION D.R. NO. IAR NO. RAMARKSQTY. ITEM

Prepared by: Certified Correct:

Division Supply Officer Schools Division Superintedent

Date Date

NAME OF SCHOOL / DISTRICT

DATE RECEIVED

UNIT COST

TOTAL COST

DEPARTMENT OF EDUCATIONDIVISION OF PANGASINAN I

Section__________________________"SAMPLE FORM ONLY"

PROJECT PROCUREMENT MANAGEMENT PLANCY 2014

Name of the Project Target Date of the Project Source of Fund Mode of Procurement1.1. Procurement of commonly used supplies/materials from PS: (see APP format) Quarterly MOOE Allocations 5,000.00 Negotiated ProcurementBallpen (Black) "Agency to Agency" Battery AA Toilet tissue paperCoupon Bond - A4Coupon Bond - Legal1.2 Ink Cartridge HP#703 & others (not available Quarterly MOOE Allocations 25,000.00 Shopping PS - DBM)2. Procurement of non-commonly used items Negotiated ProcurementConstruction Supplies/materials November MOOE Allocations 5,000.00 NP- Small ValueSports Supplie October MOOE Allocations 50,000.00 NP- Small ValueOffice Equipment December MOOE Allocations 100,000.00 NP- Small Value

April/May Venue & Accommodation IN-SET Funds 50,000.00 Shopping

Supplies and materials IN-SET Funds 10,000.00 Shopping

Total Budget Amount

Prepared by: Recommended by: Approved by:

Estimated Budget for the Contract

3. Trainings/Seminars/Workshops (EPSs)

ANNUAL PROCUREMENT PROGRAM FOR COMMONLY Name and Address of Agency:

USED SUPPLIES

(For Supplies/Materials)

For Calendar Year ______

COMMODITY - ( )-SUPPLIES/ ( )- EQUIPMENT

Unit Unit Price Total Amount Unit Qty.

C.N. (Nomenclature & Complete Specification/sDescription)

TOTAL CARRIED FORWARD

NOTE: 1. The above procurement program is in accordance with the procurement

objective of this office. SUBMITTED BY:

2. The total amount covered by this procurement program does not exceed

the total appropriation amount for supplies and materials/equipment.

jml/'11xls

Item in the Budget Page ______ of _______

Date Submitted:

D I S T R I B U T I O N B Y Q U A R T E R S

1ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER

Qty. Amount Qty. Amount Qty. Amount Qty. Amount

RECOMMENDED FOR APPROVAL: APPROVED:


CY 2013 - 2014

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSA. LAND:1 Land AreaB. LAND IMPROVEMENTC. OFFICE BUILDING: 1 Division Office Main Building 2 Division Office Annex Building 3 Division Office EDPITAF Building4 Others (Specify)D. OTHER STRUCTURES:1 Division Office Canteen 2 Division Medical/Dental Building3 Comfort Room4 Others (Specify)E. Leasehold Improvements - LandF. Leasehold Improvements - Buildings

CERTIFIED CORRECT:

Schools Division Superintendent

DESCRIPTION (INCLUDE SERIAL NO. IF AVAILABLE)

ESTIMATED LIFE YEARS

DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE


CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSG. OFFICE EQUIPMENT:123456789

1011121314151617181920

CERTIFIED CORRECT:



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE



CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSG. OFFICE EQUIPMENT:2122232425262728293031323334353637383940

CERTIFIED CORRECT:



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE



CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSG OFFICE EQUIPMENT;4142434445464748495051525354555657585960

CERTIFIED CORRECT:



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE



CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSH. FURNITURES & FIXTURES:123456789

1011121314151617181920



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE

CERTIFIED CORRECT:



CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSI. IT EQUIPMENT & SOFTWARE:123456789

10111213141516171819



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE

20CERTIFIED CORRECT:



CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSI. IT EQUIPMENT & SOFTWARE:

212223242526272829303132333435363738



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE

3940

CERTIFIED CORRECT:



CY 2013 - 2014

NO. ARTICLE PROPERTY# DEPRECIABLE COST REMARKSJ. LIBRARY BOOKS:1234567K. MOTOR VEHICLES:12345L. PUBLIC INFRASTRUCTURES:12

M. CONSTRUCTION IN PROGRESS:



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE

12

CERTIFIED CORRECT:



CY 2013 - 2014

School: _________________________________________________________

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSA. LAND:1 Land AreaB. LAND IMPROVEMENTC. OFFICE BUILDING: 1 District2 School Head

D. SCHOOL BUILDING:1 Marcos Type 2 PTA 3 Agbayani4 Duque 5 DepED6 Espino 7 Others (Please specify)E. OTHER STRUCTURE:1 School CanteenF. LEASEHOLD IMPROVEMENT - LANDG. LEASEHOLD IMPROVEMENT - BLDG.

(Continue on separate sheet if necessary)

PREPARED BY: CERTIFIED CORRECT:



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE

Supply Officer/School Property Custodian School Head


CY 2013 - 2014

School: _________________________________________________________

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSH. Office Equipment:1 Typewriter, Manual2 Electric Fan (ceiling, desk,stand)3 Calculator, battery operated4 Duplicating Machine (Photocopier)5 Airconditioner (Window type)6 Binding Machine, manual789

1011121314151617 others (please specify)





DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE



CY 2013 - 2014

School: _________________________________________________________

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSI. FURNITURES & FIXTURES:1 Clerical table2 Computer table 3 Conference table 4 Ordinary Table5 Executive table 6 Typewriter Table 7 Bench 8 Computer Chair9 Ordinary chair

10 Stacking Chair (plastic)11 Monobloc chair12 Sala set13 Cabinet steel 14 Cabinet wooden15 Safety Vault16 cabinet plastic17 blackboard, corkboard, whiteboard)





DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE



CY 2013 - 2014

School: _________________________________________________________

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSJ. IT EQUIPMENT & SOFTWARE: 1 Computer set (Desktop, laptop, notebook)2 Printer (laserjet, deskjet, dot matrix)3 Scanner 4 AVR/UPS 5 Server6 Software (operatring system) 7 Monitor8 Router9 Modem

10 Mobile stick (Broadband)11121314151617




DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE




CY 2013 - 2014

School: _________________________________________________________

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSK. LIBRARY BOOKS: 1 Generalities 2 Philosophy & Psychology3 Social Science4 Natural Science & Mathematics5 Technology (Applied Science)6 Arts7 Literature8 Geography & History9

1011121314151617



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE





CY 2013 - 2014

School: _________________________________________________________

NO. ARTICLE/ITEM PROPERTY# DEPRECIABLE COST REMARKSL. MOTOR VEHICLES:1 SUV2 CAR3 JEEP4 Trailer5 VAN

M. PUBLIC INFRASTRUCTURES:1 Artesian wells2O. CONSTRUCTION IN PROGRESS:1 DepED2 Water and Sanitation3 4 5 6 7 8



DATE ACQUIRED

ACQUISITION COST

ACCOUNTABLE OFFICE




Documents

Various Forms