ABCDEFGHIJKLMNOPQRSTUYZAAABACADAEAF
1
2
AD - REQUEST FORM
3
4
Form No. ADRF-AD-FM108Version No. 02Effectivity Date:May 14, 2025
5
6
Requisition Number:Date of Request:
7
Name of Requesting Party: Position:Signature:
8
Division/Section/Unit:
Received by:Service rendered by:
9
Date Needed:Date and Time Received:
10
Time Needed:
Date: ________________
11
Purpose:
12
13
REQUEST CATEGORY
14
15
A. SERVICE/ASSISTANCEB.
RECORDS/DOCUMENTS
C.
FACILITIES/EQUIPMENT
16
A.1) ICT ServicesA.2) HR Services
B.1
HR Documents
C.1 Use of Facilities
17
Desktop
Loans
Service Records
TMO Conf. Room
18
Laptop
Salary Deductions
Cert. of Employment
RMS Conf. Room
19
Printer
Stoppage
Cert. of Emp. & Compensation
Workshop Room
20
Internet Connection
Add'l Deduc.
(specify amt)
P____________
Cert. of Appearance
Dormitories
21
Systems
Cert. of No Pending Admin. Case
Executive House
22
Software
Cert. of Completion (OJT)
No. of Occupants
23
Website Posting
Emp Verification
Cert. of Leave Credits
Female
24
Email
Submission of Docs
Authority to Travel Abroad
Male
25
Projector
Filing
Total:____________________
26
Mobile
Claims
B.2
Copy of Records
C.2
Use of Equipment
27
TV
A.3) General Services
Memorandum/a
Laptop
28
Tablet
Email
Office Order
Projector
29
Consultancy
Scan
Special Order for SDO
TV
30
Tutorial
Delivery
Travel Order
Microphone (Wired/Wireless)
31
Drivers USB/E-HDD
Payslip (Specify month):________
Contract
Portable PA System
32
Check-up
Guidelines/Policies
Binding Machine
33
Set-up
PhotocopyNote: All documents will be stamped with "Certified True Copy"
C.3 Transportation Services
34
Password Reset
No. of copies: _____
VEHICLE
35
Prev. Maint.
No. of Pages: ______
Destination:
36
Back-up
A.4) Maintenance Services
37
Repair
Janitorial Assistance
38
Installation
Minor Repair
Conduction only
39
New Email
Furniture and Fixture
Conduction to and from
40
Borrow
Electrical works
Name of Passengers
41
Return
Water system
1. ____________________________________
42
Format
Telephone lines
2. ____________________________________
43
Zoom Meeting
3.____________________________________
44
Title of the meeting:
4. ____________________________________
45
Date and Time:__________________________________________________________
5. ____________________________________
46
Email address (where to send the link):_______________________________
Remarks:
47
Password Reset (Indicate the alternate email address)
48
New Email (pls. register to this link http://bit.ly/4hU144j)
49
Findings and Recommendation:
OTHERS (Not Specified Above)
50
51
A.5) Procurement Services
52
Posting/Canvassing
53
Extension
54
Cancellation
ACTION ON REQUEST (For ADMIN action)
55
Please specify title of the project: ______________________________________
Approved
56
No. of days extension/Reposting: ______________________________________
Disapproved
57
Reason for cancellation: ________________________________________________
Reason:
58
59
Recommending Approval:Approved by:
60
61
62
Section Head ConcernedDivision Chief Concerned/PPO IV/ARD-Designate
63
64
65
66
67
68
69
70
71
Instructions:
72
1Kindly accomplish the form properly and completely.
73
2The Division/Section concerned will provide the"Requisition Number" for control.
74
3Select under Request Category by putting an “X” mark in the box to indicate the kind of request whether Service, Document, Facilities or Equipment as well as the categories listed in the form.
75
4The Recommending Approval shall be signed by the Section Head while Approval shall be signed by the concerned Division Chief / PPO IV/ARD.
76
5AD shall either approve or disapprove the request and affix his/her initial beside the Action Request. If disapproved, AD shall state the reason for disapproval.
77
6After the request has been served, please fill-out the attached Client Satisfaction Measurement (CSM) and submit to the designated CSM Focal Person in your Division/Region for the consolidation and preparation of report.
78
7Avoid alteration or erasures.
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100