Standard Form Number: SF-GOOD-63
Standard Form Number: SF-GOOD-63
Standard Form Title: Agency Procurement RequestNAME AND ADDRESS
AGENCY
OF REQUESTING ACCT. CODE
AGENCY AGENCY CONTROL No.
AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM Compound, RR Road
Cristobal St., Paco Manila
(Date Prepared)
ACTION REQUESTED ON THE ITEM LISTED BELOW
[ ] Please furnish us with the Price Estimate (for office
equipment/furniture & supplementary items)
[ ] Please purchase for our agency the
equipment/furniture/supplementary items per your 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
[ ] Others
(Specify)_______________________________________________________________________________________
IMPORTANT!! PLEASE SEE THE INSTRUCTION/CONDITIONS AT THE BACK OF
THE ORIGINAL COPY
ITEMITEM AND DESCRIPTION SPECIFICATIONS/STOCK
No.QUANTITYUNITUNIT PRICEAMOUNT
NO.
Total AMOUNT P
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCK REQUESTED ARE CERTIFIED TO BE
WITHIN APPROVED PROGRAM:
----------------------------------------------------------
AGENCY PROPERTY SUPPLY OFFICERFUNDS CERTIFIED AVAILABLE:
----------------------------------------------------------
AGENCY CHIEF ACCOUNTANTAPPROVED:
-----------------------------------------------AGENCY
HEAD/AUTHORIZED SIGNATURE
[ ] FUND DEPOSITE WITH PS [ ] _________________ CHECK No.
____________________
IN THE AMOUNT OF:
____________________________________________________________ (P )
ENCLOED
