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NAME AND ADDRESSDepEd Southern Leyte Division
AGENCY
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OF REQUESTINGMantahan, Maasin City, Southern Leyte
ACCT. CODE
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AGENCYTel. Nos. 053-570-8930 to 33 Fax No. 053-381-3835 AGENCY CONTROL No.
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AGENCY PROCUREMENT REQUEST
PS APR No.
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To:
THE PROCUREMENT SERVICE
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DBM - Region VIII DEPOT
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PEO, CAPITOL SITE,
(Date Prepared)
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Maasin City, Southern Leyte
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ACTION REQUESTED ON THE ITEM LISTED BELOW
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Please furnish with us the Price Estimate (for office equipment/furniture & supplementary items)
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Please purchase for our agency/furniture/ supplementary items per you Price Estimate
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(PS RAD No. _______________ attached) dated _____________________________
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Please issue common-use supplies/materials per price list as of _____________________________
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Please issue Certificate or Price Reasonableness
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Please furnsih us with your latest/updated Price List
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Others, pls. specify ______________________________________________________
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 IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK OF ORIGINAL COPY
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ITEM NO.ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO.QUANTITYUNITUnit PriceAMOUNT
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Total AMOUNT
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NOTE : ALL SIGNATURES MUST BE OVER PRINTED NAME
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STOCKS REQUESTED ARE CERTIFIED TO BE
FUNDS CERTIFIED AVAILABLE:
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WITHIN APPROVED PROGRAM:
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PROPERTY CUSTODIANDISBURSING OFFICERSCHOOL HEAD
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FUNDS DEPOSITED WITH PS
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_________________ CHECK No. ______________
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