Name and Address: AGUSUHIN HIGH SCHOOL AGENCY ACCT CODE:

REQUESTING AGENCY: Subic, Zambales

Tel Nos. 09083103170 AGENCY CONTROL NO:

AGENCY PROCUREMENT REQUEST PS APR NO.

To: PROCUREMENT SERVICE
Dbm Compound, RR Road
Cristobal St., Paco, Manila

PLEASE CHECK (√)APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

□Please issue common use supplies/materials per price list no. ______________ dated _________________
Mode of delivery □pick up (fast lane) □pick up (schedule) □Delivery (door to door)
In case fund is not sufficient □reduce quantity□bill us □charge to unutilized deposit, APR No. ____Date:_____

□Please purchase for our agency non-common items, attached herewith:

□Complete specifications □Obligation Request (ObR) □Others, pls. specify _________________

□Certificate of Budget Allocation (CBA) □Payment

This form shall be prepared for requisition of Common-Use Goods from the PS Depots & Sub-Depots; and for orders of consumables & non-
consumables Use Supplies for the PS Main.
For PS Main-Common Use Supplies, please use Form 001 or Form 0091 B
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
1 Avision 49 Inch UHD Smart Digital LEDTV 49K788U with WallBracket 1 unit 17500 17 500.00
2 Titanium Audio TA9000 UHF Professional Wireless Microphone 1 unit 2000 20 000.00
3 Original Konzert AV-502B 500W x 2 Karaoke Amplfier 1 unit 4000 4 000.00
4 Yamaha 4 CHANNEL mixer with Usb & Bluetooth 1 unit 2000 2 000.00
5 Epson EB-X41 XGA 3LCD Technology, RGB Liquid Crystal Shutter 3,600 1 unit 24000 24 000.00
Lumens Multimedia Projector
6 White Board 4 unit 720 2 880.000
7 Globe At Home Prepaid WiFi 1 unit 2000 2 000.00
8 Network Routers-Linksys E1200 Wireless N Router-(Black) 1 unit 2100 2 100.00
9 Hub/Switches-16 Port Ethernet Switch Network Hub 10/100Mbps 1 unit 1200 1 200.00
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
TOTAL AMOUNT 73, 680.00

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:

WITHIN APPROVWED PROGRAM

FERDINAND B. DUCUT _________________________________ FRANCISCO G. APURIT

Agency Property/Supply Officer AGENCY CHIEF ACOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

□ FUNDS DEPOSITED WITH PS □ _________________ CHECK NO. _____________________

IN THE AMOUNT OF _________________________________________________________________ (p_______________) ENCLOSED
APR FORM Revised May 2015 FORM NO. 002
Name and Address: AGUSUHIN HIGH SCHOOL AGENCY ACCT CODE:
REQUESTING AGENCY: Subic, Zambales
Tel Nos. 09083103170 AGENCY CONTROL NO:

AGENCY PROCUREMENT REQUEST PS APR NO.

To: PROCUREMENT SERVICE
Dbm Compound, RR Road
Cristobal St., Paco, Manila

PLEASE CHECK (√)APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

□Please issue common use supplies/materials per price list no. ______________ dated _________________
Mode of delivery □pick up (fast lane) □pick up (schedule) □Delivery (door to door)
In case fund is not sufficient □reduce quantity □bill us □charge to unutilized deposit, APR No. ____Date:_____

□Please purchase for our agency non-common items, attached herewith:

□Complete specifications □Obligation Request (ObR) □Others, pls. specify _________________

□Certificate of Budget Allocation (CBA) □Payment

This form shall be prepared for requisition of Common-Use Goods from the PS Depots & Sub-Depots; and for orders of consumables & non-
consumables Use Supplies for the PS Main.
For PS Main-Common Use Supplies, please use Form 001 or Form 0091 B
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
1 Avision 49 Inch UHD Smart Digital LEDTV 49K788U with WallBracket 1 unit 17500 17 500.00
2 Titanium Audio TA9000 UHF Professional Wireless Microphone 1 unit 2000 20 000.00
3 Original Konzert AV-502B 500W x 2 Karaoke Amplfier 1 unit 4000 4 000.00
4 Yamaha 4 CHANNEL mixer with Usb & Bluetooth 1 unit 2000 2 000.00
5 Epson EB-X41 XGA 3LCD Technology, RGB Liquid Crystal Shutter 3,600 1 unit 24000 24 000.00
Lumens Multimedia Projector
6 White Board 4 unit 720 2 880.000
7 Globe At Home Prepaid WiFi 1 unit 2000 2 000.00
8 Network Routers-Linksys E1200 Wireless N Router-(Black) 1 unit 2100 2 100.00
9 Hub/Switches-16 Port Ethernet Switch Network Hub 10/100Mbps 1 unit 1200 1 200.00
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

TOTAL AMOUNT 73, 680.00

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:

WITHIN APPROVWED PROGRAM

FERDINAND B. DUCUT _________________________________ FRANCISCO G. APURIT

Agency Property/Supply Officer AGENCY CHIEF ACOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

□ FUNDS DEPOSITED WITH PS □ _________________ CHECK NO. _____________________

IN THE AMOUNT OF _________________________________________________________________ (p_______________) ENCLOSED
APR FORM Revised May 2015 FORM NO. 002
Name and Address: AGUSUHIN HIGH SCHOOL AGENCY ACCT CODE:
REQUESTING AGENCY: Subic, Zambales
Tel Nos. 09083103170 AGENCY CONTROL NO:

AGENCY PROCUREMENT REQUEST PS APR NO.

To: PROCUREMENT SERVICE
Dbm Compound, RR Road
Cristobal St., Paco, Manila

PLEASE CHECK (√)APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

□Please issue common use supplies/materials per price list no. ______________ dated _________________
Mode of delivery □pick up (fast lane) □pick up (schedule) □Delivery (door to door)
In case fund is not sufficient □reduce quantity □bill us □charge to unutilized deposit, APR No. ____Date:_____

□Please purchase for our agency non-common items, attached herewith:

□Complete specifications □Obligation Request (ObR) □Others, pls. specify _________________

□Certificate of Budget Allocation (CBA) □Payment

This form shall be prepared for requisition of Common-Use Goods from the PS Depots & Sub-Depots; and for orders of consumables & non-
consumables Use Supplies for the PS Main.
For PS Main-Common Use Supplies, please use Form 001 or Form 0091 B
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
First Aid Kit
Mega Phone
Transistor Radio with Batteries
Flash Light with Batteries
Whistle

22
23
24
25
26
27
TOTAL AMOUNT
GRAND TOTAL: PAGE 1 + 2

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:

WITHIN APPROVWED PROGRAM

FERDINAND B. DUCUT _________________________________ FRANCISCO G. APURIT

Agency Property/Supply Officer AGENCY CHIEF ACOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

□ FUNDS DEPOSITED WITH PS □ _________________ CHECK NO. _____________________

IN THE AMOUNT OF _________________________________________________________________ (p_______________) ENCLOSED
APR FORM Revised May 2015 FORM NO. 002
Name and Address: AGUSUHIN HIGH SCHOOL AGENCY ACCT CODE:
REQUESTING AGENCY: Subic, Zambales
Tel Nos. 09083103170 AGENCY CONTROL NO:

AGENCY PROCUREMENT REQUEST PS APR NO.

To: PROCUREMENT SERVICE
Dbm Compound, RR Road
Cristobal St., Paco, Manila

PLEASE CHECK (√)APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

□Please issue common use supplies/materials per price list no. ______________ dated _________________
Mode of delivery □pick up (fast lane) □pick up (schedule) □Delivery (door to door)
In case fund is not sufficient □reduce quantity □bill us □charge to unutilized deposit, APR No. ____Date:_____

□Please purchase for our agency non-common items, attached herewith:

□Complete specifications □Obligation Request (ObR) □Others, pls. specify _________________

□Certificate of Budget Allocation (CBA) □Payment

This form shall be prepared for requisition of Common-Use Goods from the PS Depots & Sub-Depots; and for orders of consumables & non-
consumables Use Supplies for the PS Main.
For PS Main-Common Use Supplies, please use Form 001 or Form 0091 B
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
1 EPSON L360 Colored INK SET 1 Bottle 900 900.00
2 EPSON L360 Black Ink 2 Bottle 300 600.00
3 EPSON L3110 Colored INK SET 1 Bottle 900 900.00
4 EPSON L3110 Black 2 Bottle 300 600.00
5 Cannon G2000 Colored SET 1 Bottle 900 900.00
6 Cannon G2000 Black SET 2 Bottle 300 600.00
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
27
TOTAL AMOUNT 4500.00
GRAND TOTAL: PAGE 1 + PAGE 2

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:

WITHIN APPROVWED PROGRAM

FERDINAND B. DUCUT _________________________________ FRANCISCO G. APURIT

Agency Property/Supply Officer AGENCY CHIEF ACOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

□ FUNDS DEPOSITED WITH PS □ _________________ CHECK NO. _____________________

IN THE AMOUNT OF _________________________________________________________________ (p_______________) ENCLOSED

APR FORM Revised May 2015 FORM NO. 002

Name and Address: AGUSUHIN HIGH SCHOOL AGENCY ACCT CODE:
REQUESTING AGENCY: Subic, Zambales
Tel Nos. 09083103170 AGENCY CONTROL NO:

AGENCY PROCUREMENT REQUEST PS APR NO.

To: PROCUREMENT SERVICE
Dbm Compound, RR Road
Cristobal St., Paco, Manila

PLEASE CHECK (√)APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

□Please issue common use supplies/materials per price list no. ______________ dated _________________
Mode of delivery □pick up (fast lane) □pick up (schedule) □Delivery (door to door)
In case fund is not sufficient □reduce quantity □bill us □charge to unutilized deposit, APR No. ____Date:_____

□Please purchase for our agency non-common items, attached herewith:

□Complete specifications □Obligation Request (ObR) □Others, pls. specify _________________

□Certificate of Budget Allocation (CBA) □Payment

This form shall be prepared for requisition of Common-Use Goods from the PS Depots & Sub-Depots; and for orders of consumables & non-
consumables Use Supplies for the PS Main.
For PS Main-Common Use Supplies, please use Form 001 or Form 0091 B
ITEM ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
1 Bond Paper A4 30 Ream 115.62 1,860.00
2 Bond Paper Legal 30 Ream 131.23 3,936.90
3 Scissor 12 Piece 15.75 189.00
4 Glue 20 Piece 12.00 240.00
5 Sign Pen black 12 Piece 34.94 419.28
6 Cutter knife 12 Piece 27.67 332.04
7 Canon G2000 Inkjet Ink Black 3 Set 100.00 300.00
8 Glue 20 Piece 12.00 240.00
9 Sign Pen black 12 Piece 34.94 419.28
10 Epson L360 Black 3 Set 125.00 375.00
11 Permanent Marker Black 12 Piece 9.74 116.88
12 Toilet bowl cleaner 10 Bottle 42.00 420.00
13 Detergent powder all purposes 10 Pack 37.00 370.00
14 Acetate 1 roll 744.32 744.32
15 Fire extinguisher, dry chemical 1 unit 1,155.00 1,155.00
16 Sign pen black 20 piece 34.94 698.80
17 solignum 2 can 1,000.00 2,000.00
18 Prepaid Home wifi 1 unit 2,000.00 2,000.00
19 Correction tape 20 piece 17.72 354.40
20 Fancy folder legal size 15 piece 255.73 3,835.95
21 Data File box 10 piece 72.57 725.70
22 Staple wire #35 10 box 35.00 350.00
23
24
25
26
27
TOTAL AMOUNT
GRAND TOTAL: PAGE 1 + PAGE 2 21,095.15

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:

WITHIN APPROVWED PROGRAM

FERDINAND B. DUCUT _________________________________ FRANCISCO G. APURIT

Agency Property/Supply Officer AGENCY CHIEF ACOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

□ FUNDS DEPOSITED WITH PS □ _________________ CHECK NO. _____________________

IN THE AMOUNT OF _________________________________________________________________ (p_______________) ENCLOSED