Department of Education

Division of Romblon
District of Sanat Fe-San Jose
DANAO NORTE ELEMENTARY SCHOOL

SUMMARY OF PROPOSED EXPENDITURES

CY 2021

Distribution By Month
Commodity
January February March April May June July August September October November December Total

A. Travel 35,000.00 35,000.00

B. Office & School Supplies
25,500.00 29,980.00 55,480.00

C. Printing Expenses 7,850.00 7,850.00 2,250.00 7,850.00 7,850.00 33,650.00

D. Medicine -
E. Other Supplies Exp. (gas,moving-
up, grad.exp.) 14,000.00 14,000.00

F. Job Order 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 24,000.00

G. Utilities (elec, water, cable, etc. ) 1,500.00 1,500.00 1,500.00 850.00 850.00 1,500.00 1,500.00 1,500.00 1,500.00 1,500.00 1,500.00 1,500.00 16,700.00
H. Repair & Maintenance - School
Building -

I. GAD ( 5% ) 12,207.50 12,207.50

J. Differently Abled ( 1% ) 2,441.50 2,441.50

TOTAL 36,850.00 33,480.00 25,350.00 2,850.00 2,850.00 8,191.50 23,557.50 3,500.00 11,350.00 38,500.00 3,500.00 3,500.00 193,479.00

Certified Correct:

ELJUN F. DELOS REYES MARIA LUISA D. SERVANDO, Ph.D.,CESO VI

ES PRINCIPAL Schools Division Superintendent
 No.:
LIQUIDATION REPORT
Date:
Responsibility Center
Department of Education
Code:
PARTICULARS Amount

Liquidation of Cash Advance as per supporting papers hereto

attached…

TOTAL AMOUNT SPENT

AMOUNT OF CASH ADVANCE PER DV# _________ DTD.

AMOUNT REFUNDED PER OR# DTD.

AMOUNT TO BE REIMBURSED
A Certified: Correctness of the B Certified: Purpose of C Certifified:Supporting
above data travel/cash advance duly documents complete & proper
accomplished

ROGER F. CAPA LEETAH F. MENORCA

 Asst. Schools Division Superintendent
OIC- Schools Division
Claimant Superintendent Accountant III JEV No.
 PURCHASE REQUEST
Department of Education
DIVISION OF ROMBLON
(INSERT YOUR DISTRICT HERE)
ROMBLON

Department: EDUCATION PR No.: Date:

Section: (School) SA No.: Date:
ALOBS No.: Date:

Stock Unit
Unit Item Description Quantity Total Cost
No. Cost
001 pcs Hard drive 5 3800.00 19000.00
002 pcs Glue 24 50.00 1200.00
003 rms Coupon bond 20 200.00 4000.00
004 pcs Printer Ink (black) 6 380.00 2280.00
005 pcs Printer Ink (magenta) 3 380.00 1140.00
006 pcs Printer Ink (Cyan) 3 380.00 1140.00
007 pcs Printer Ink (Yellow) 3 380.00 1140.00
008 pcs Specialty paper 10 100.00 1000.00
009 pcs Electric Fan 1 2100.00 2100.00
010 pcs Medals 40 35.00 1400.00

TOTAL ₱ 34,400.00
Purpose: Purpose : Purchase materials for school and office supplies.

Requested by: Approved by:

Signature:
Printed Name: ELJUN F. DELOS REYES MARIA LUISA D. SERVANDO,Ph.D.,CESO VI
Designation ES Principal II Schools Division Superintendent
 DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
SILVINO G. GAJARION ELEMENTARY SCHOOL
Romblon
CANVASS OF PRICE QUOTATION
Date

Sir/Madam:

Please qoute your price on the articles/services describe below for immediate
delivery/accomplishment we may purchase from you, any or all of the articles/services/, and
may award you the services if your quotations are considered reasonable:

MARY JANE R. MARIANO

BAC CHAIRMAN
Item No. Quantity Unit Articles/Services Unit Price Total Cost
013 5 box Correction tape
014 10 pcs Sign pin .70
015 10 reams parchment paper
011 2 pcs Printer
017 10 pcs specilaty paper

I/WE HEREBY PROMISE to deliver immediately upon reciept of your order for the above
mentioned articles described according to specification and price as stated opposite each
item.

Date: _______________________ Signature

 ABSTRACT OF QUOTATIONS AND CERTIFICATE OF REASONABLENESS OF PRICES
(Pertaining of the Local Purchase of Supplies, Materials and Equipment made in accordance with paragraph 4 of Department of Finance Order No. 2, series of 1956)

Name of Bidders and their respective prices

Item No. Quantity Unit Name of Articles Winning Bidder
JA WAREHOUSE HIA SCHOOL & OFFICE DEPOT S.I.G.E Trading

001 15,400.00 15,600.00 JA WAREHOUSE

4 rms Hard drive 15200.00

011 1 12,450.00 JA WAREHOUSE

pc Printer (3in 1) 12400.00 12,500.00

012 2 410.00 JA WAREHOUSE

reams Neon Paper 400.00 420.00

003 22 4,620.00 JA WAREHOUSE

reams Coupon bond 4400.00 4,730.00

I HEREBY CERTIFY that the above prices which are checked and initialed are reasonable and the lowest obtainable in the locality after canvassing local dealers.

MARY JANE R. MARIANO MARY JEAN

BAC Vice F. ANDRES
Chairman MARIVIC G. MADRID RUTH G. DELOS REYES REDELYN C. MONTOJO
BAC Chairman BAC Member BAC Member BAC Member
 PURCHASE ORDER
Department of Education
DIVISION OF ROMBLON
ROMBLON
Supplier:
Address:
TIN:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions
contained herein:
Place of Delivery: (FOB-SHIPPING POINT)
(FOB-DESTINATION)
Date of Delivery:
Unit
Stock No. Unit Item Description Quantity Amount
Cost
013 box Correction tape 5 500.00 2500.00
014 pcs Sign pin .70 10 150.00 1500.00
015 reams parchment paper 10 100.00 1000.00
011 pcs Printer 2 14,200 28400
017 pcs specilaty paper 10 100 1000

(Total Amount in Words) Thirty four thousand four hundred pesos only. ₱ 34,400.00
In case of failure to make the full delivery within the time specified above, a penalty of one-
tenth (1/10) of one percent for every day of delay shall be imposed.
Very truly yours,

ELJUN F. DELOS REYES

PRINCIPAL
Conforme:

Signature Over Printed Name of Supplier

Date
Funds Available:
ALOBS No.:
LEETAH F. MENORCA Amount:
Accountant III
 INSPECTION AND ACCEPTANCE REPORT
Department of Education
DIVISION OF ROMBLON
SANTA FE-SAN JOSE DISTRICT
ROMBLON
Supplier IAR No.
P.O. No. Date: Invoice No. Date:
Requisitioning Officer/Dept.

Stock No. Unit Description Quantity

005 rms Coupon bond 50
006 pcs Glue 24
007 pcs Neon paper 2
008 pcs Folder 24
009 pcs Plastic envelope 24
010 pcs Assorted clay 50
011 pcs Writing board 2
012 pcs wooden numbers 2
013 pcs Wooden blocks shape 3
014 pcs Alphabet Flash cards 2
015 pcs Number Flash Cards 2
016 pcs Pop It 10
017 pcs Crayons (doubled) 10
018 pcs Water color 10
019 pcs Wooden blocks alphabet 2
020 pks Popsicles 10
021 pcs Printer Ink black 3
022 pcs Printer Ink magenta 3
023 pcs Printer Ink cyan 3
024 pcs Printer Ink yellow 3
025 pcs Plastic plate 12
026 kl Spoon (plastic) 1/2
027 kl Fork (palstic) 1/2
028 pcs Water jug 1
029 pcs door mat 4
030 pcs Dish rack 1
031 pcs Glass (plastic) 12
032 pcs Cartolina(assorted) 44
INSPECTION ACCEPTANCE

Date Inspected: Date Received

Inspected, verified and found in order as Complete

to quantity and specifications Partial

SONET JOY I. JUNGAY WAIVI M. VILLAFLOR

Member Member

EMY E. MONTOJO
Property Custodian

MYNIE B. TABUNA
Member
 INSPECTION AND ACCEPTANCE REPORT
Department of Education
DIVISION OF ROMBLON
SANTA FE-SAN JOSE DISTRICT
ROMBLON
Supplier IAR No.
P.O. No. Date: Invoice No. Date:
Requisitioning Officer/Dept.

Stock No. Unit Description Quantity

001 pcs Hard drive 5
002 pcs Glue 24
003 rms Coupon bond 20
004 pcs Printer Ink (black) 6
005 pcs Printer Ink (magenta) 3
006 pcs Printer Ink (Cyan) 3
007 pcs Printer Ink (Yellow) 3
008 pcs Specialty paper 10
009 pcs Electric Fan 1
010 pcs Medals 40

INSPECTION ACCEPTANCE

Date Inspected: Date Received

Inspected, verified and found in order as Complete

to quantity and specifications Partial

SONET JOY I. JUNGAY WAIVI M. VILLAFLOR

Member Member

EMY E. MONTOJO
Property Custodian

MYNIE B. TABUBA
Member
 INSPECTION AND ACCEPTANCE REPORT
Department of Education
DIVISION OF ROMBLON
SANTA FE-SAN JOSE DISTRICT
ROMBLON
Supplier IAR No.
P.O. No. Date: Invoice No. Date:
Requisitioning Officer/Dept.

Stock No. Unit Description Quantity

001 pc Safeguard 20
002 gal Alcohol 12
004 box Vitamins 25
003 pc Hand Sanitizer 50
005 box Facemask 50
006 pc Faceshield 20
007 pc Handsoap 10
008 pc Footbath 10
009 pc Atomizer Disinfictant Fog Smoke Machine 1

INSPECTION ACCEPTANCE

Date Inspected: Date Received

Inspected, verified and found in order as Complete

to quantity and specifications Partial

SONET JOY I. JUNGAY WAIVI M. VILLAFLOR

Member Member

EMY E. MONTOJO
Property Custodian

MYNIE B. TABUNA
Member
 INSPECTION AND ACCEPTANCE REPORT
Department of Education
DIVISION OF ROMBLON
SANTA FE-SAN JOSE DISTRICT
ROMBLON
Supplier IAR No.
P.O. No. Date: Invoice No. Date:
Requisitioning Officer/Dept.

Stock No. Unit Description Quantity

26 pcs Medals 100
27 pcs Ribbons 200

28 pcs Corsage 20
29 pcs Certificate frame 20
30 m Geena cloth 20

INSPECTION ACCEPTANCE

Date Inspected: Date Received

Inspected, verified and found in order as Complete

to quantity and specifications Partial

LOVELLE M. GUYO WAIVI M. VILLAFLOR

Member Member

EMY E. MONTOJO
Property Custodian

MYNIE B. TABUNA
Member
 CS Form No.
(Revised 1998)

DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
(INSERT YOUR DISTRICT HERE)
Romblon

JOB ORDER

Department/Division: ROMBLON Source of Fund:

Date Prepared:

Name of Rate per Period of If Renewal (Incl.Date of

Position Employment To
Appointee/s Day From Previous Employment)

The above named personnel are hereby hired/appointed as casuals at the rate of compensation stated
opposite their/his name(s) for the period indicated. It us understood that such employment will cease
automatically at the end of the period stated unless renewed. Any of all them may be laid - off any time before
the expiration of the employment period when their services are no longer available of the project has already
been completed/finished or their performance are below par.

LEETAH F. MENORCA
Accountant III

___________________
Date

RECOMMENDING APPROVAL: APPROVED:

ROGER F. CAPA
School Head OIC-SDS
___________________ ___________________
Date Date
 REQUISITION AND ISSUE SLIP
DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
SANTA FE- SAN JOSE DISTRICT
ROMBLON

Division ROMBLON Responsibility Center Code: DATE

Office/Distric

Requisition Issuan ce
Stock No. Unit Description Quantity Quantity Remarks
15 reams parchment paper 10 10 Complete
17 pks specialty paper 10 10 Complete

Purpose: Received school supplies.

Requested by: Approved by: Received by:

Issued by:

Signature
Printed Name MARY JANE R. MARIANO ELJUN F. DELOS REYES EMY E. MONTOJO MARY JANE R. MARIANO
Designation Teacher ESP-II Property Custodian Teacher
Date
 REQUISITION AND ISSUE SLIP
DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
SANTA FE- SAN JOSE DISTRICT
ROMBLON

Division ROMBLON DATE

Office/Distric

Requisition Issuan ce
Stock No. Unit Description QTY Quantity Remarks
002 pcs Glue 8 8 Completed
003 rms Coupon bond 2 2 Completed
8 pcs Specialty paper 1 1 Completed

Purpose: Received Office Supplies.

Requested by: Received by:

Issued by:

Signature
Printed Nam ELJUN F. DELOS REYES EMY E. MONTOJO EMY E. MONTOJO
Designation School Head Property Custodian Adviser
Date
 REQUISITION AND ISSUE SLIP
DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
SANTA FE- SAN JOSE DISTRICT
ROMBLON
Division ROMBLON Responsibility Center Code: DATE
Office/District:

Requisition Issuan ce
Stock No. Unit Description Quantity Quantity Remarks
1 Sitaw 2000 Completed
grams 2000

2 Baguio Beans 2500 Completed

grams 2500

3 Banana heart 6000 Completed

grams 6000

4 Banana Saba 1000 Completed

grams 1000

5 Munggo sprouted 1000 Completed

grams 1000

6 Bell pepper (red) 1000 Completed

grams 1000

7 Camote dilaw 5000 Completed

grams 5000

8 Carrots 3500 Completed

grams 3500

9 onion leaves 1500 Completed

grams 1500

10 11500 Completed
ml Coconut milk 1st extract 11500

11 Eggplant 1500 Completed

grams 1500

12 ampalaya 1500 Completed

grams 1500

13 Garlic 2000 Completed

grams 2000

14 Ginger 100 Completed

grams 100

15 Fresh corn grated 3500 Completed

grams 3,500

16 grams mami sariwa 5000 5000 Completed

17 Onion Bumbay 200 200 Completed
grams

18 Lumpia wrapper 3500 3500 Completed

grams

19 Munggo, green 9000 9000 Completed

grams

20 Abitsuelas 1300 1300 Completed

grams

21 Okra 1000 1000 Completed

grams

22 Onion 8800 Completed

grams 8800

23 Sili leaves 1300 Completed

grams 1300

24 Patola 2500 Completed

grams 2500

25 grams Pechay 1500 1500 Completed

26 Squash 3500 Completed
grams 3500

27 Sweet corn, young 5000 Completed

grams 5000

28 Sweet potato/kamote 16000 Completed

grams 16000

29 Kangkong leaves 1000 Completed

grams 1000

30 Tokwa 3000 Completed

grams 3000

31 Tomato 10500 Completed

grams 10500
Purpose: Received materials for SBFP.

Requested by: Approved by: Received by:

Issued by:

Signature
Printed Name MARY JANE R. MARIANO ELJUN F. DELOS REYES EMY E. MONTOJO MARYA JANE R. MARIANO
Designation SBFPC ESP-1 Property Custodian SBFPC
Date
 INVENTORY CUSTODIAN SLIP
SANTA FE-SAN JOSE DISTRICT
ROMBLON
ICS No. ______

Item Inv. Item Estimated

Qty Unit Item Description Unit Value Total Value
No. No. Useful Life

001 1 pcs Hard drive 1 3 years 3,800.00 3,800.00

Received by: Received from:

MARY JANE R. MARIANO EMY E. MONTOJO

Signature Over Printed Name Signature Over Printed Name
Teacher School Property Custodian
Position/Office Position/Office

Date Date
 Department of Education
Division of Romblon
District of _________________
(School)

ANNUAL PROCUREMENT PLAN

Distribution By Month
No. Commodity
Unit Total Total
Price Quantity Amount January February March April May June July August September October November December
Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount Quantity Amount

A. Travel

Sub-Total
B. Office & School Supplies

Sub-Total

C. Printing Expenses

Sub-Total

D. Medicine

E. Other Supplies Exp. (gas,moving-up,

grad.exp.)

F. Job Order

G. Utilities (elec, water, cable, etc. )

H. Repair & Maintenance - School Building

I. GAD (5%)

J. Differently Abled (1%)

Sub-Total

TOTAL
Prepared & Submitted: Approved:

0 ROGER F. CAPA
School Head Schools Division Superintendent
 REQUISITION AND ISSUE SLIP
DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
SANTA FE- SAN JOSE DISTRICT
ROMBLON

Division ROMBLON DATE

Office/District:

Requisition Issuan ce
Quantity
Stock No. Unit Description Quantity Remarks
002 pcs Glue
4 4 Completed
003 pack Photo paper
1 1 Completed
004 pcs certificate holder
5 5 Completed
005 pcs Certificate Frame
5 5 Completed
006 pck Parchment Paper
5 5 Completed
007 pck Special Paper
2 2 Completed

Purpose: Received school and office supplies.

Requested by: Approved: Received by:

Isssued by:

Signature
Printed Name WAIVI M. VILLAFLOR ELJUN F. DELOS REYES EMY E. MONTOJO WAIVI M. VILLAFLOR
Designation Grade 2 Principal I Property Custodian Grade 2
Date
 Republic of the Philippines
Department of Education
Region IV - MIMAROPA
DIVISION OF ROMBLON
SANTA FE-SAN JOSE DISTRICT
Romblon, Romblon

PROGRAM OF WORK / BUDGET COST

Date: November 3, 2023
MAINTENANCE
( Project Category)

Name of Project: Repair of access road Implementation Procedure by:

Description/Dimension:
Location: Guinbirayan Elementary School
Appropriation/SAA: Php 17,950.00
Source of Funds: MOOE
Classifications:
Desirable Starting Date: November 23, 2023
Target Completion Date:

Item: DESCRIPTION OF ITEM PERCENTAGE Amount

MATERIALS:
043 Cement 53.47 9600
044 Sand 25.1 4500
045 Pebbles 16.7 3000
045 Shovel 4.73 850

Sub-total 100.00
LABOR:

Sub-total 0.00 0.00

100%
TOTAL DIRECT COST 17950.00
BREAKDOWN ESTIMATED COST
AMOUNT % TOTAL
1 Labor - -
2 VAT inclusive
3 Material Cost 17,950.00 100.00
4 Contingencies
5 Equipment Rental
TOTAL PROJECT COST 17,950.00 100.00
Prepared by:
Approved by

EFREN D. MARCELINO JR
School Desig. Physical Facil. Coordinator
ELJUN F. DELOS REYES
Elementary School Principal I

Checked & Reviewed:

Engr. EUCARITO V. GACUTNO

Engineer III
 810370468.xlsx

DETAILED ESTIMATE
Item ____A_____
Description of Item: QUANTITY:
DURATION: days
A. LABOR:
( Exclude Acquisition and Delivery of Materials)
DESCRIPTION NUMBER NO. OF DAYS MEN-DAYS RATE/DAY AMOUNT

-
-
-
-
-
-
-
-
Sub-total -
B. MATERIALS
( Exclude Acquisition and Delivery of Materials)
KIND/DESCRIPTION OF MATERIALS QUANTITY UNIT UNIT COST AMOUNT
Cement 30 sacks 320.00 9,600.00
sand 3 cu 1,500.00 4,500.00
Pebbles 2 cu 1,500.00 3,000.00
Shovel 1 pc 850.00 850.00
-
-
-
-
-
-
-
-

Sub-total 17,950.00
Total Cost of Item 17,950.00

Prepared by: Approved by

ELJUN F. DELOS REYES

EFREN D. MARCELINO JR School Head
School Desig. Physical Facil. Coordinator

Checked and Reviewed:

Engr. EUCARITO V. GACUTNO

Engineer III
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IV-MIMAROPA
DIVISION OF ROMBLON
Romblon, Romblon

AUTHORITY TO TRAVEL

NAME: MARIA LYNETTE A. MOLEÑO

OFFICIAL STATION: Silvino G. GajarionES

DESTINATION: SDO Romblon

PERIOD OF TRAVEL: 14-Aug-19

PURPOSE OF TRAVEL: To attend Division Rabiez Quiz Bee and

Poster Making Contest.
ESTIMATED EXPENSES:

CHARGED TO:

Subject to the usual accounting and auditing rules and regulations.

Requested by:

ELJUN F. DELOS REYES

ESP-1

Approved:

ROGER F. CAPA
Schools Division Superintendent

Funds Available:

LEETAH F. MENORCA
Accountant III
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IV-MIMAROPA
SCHOOL DIVISION OFFICE-ROMBLON
Romblon, Romblon
ITINERARY OF TRAVEL No. Date:
Name: Position: 9/2/2019 Monthly Salary
Maria Lynette A. Moleño
MT-I 40,637.00
Official Station: Residence:
Silvino G. Gajarion ES Guinbirayan, Sta. Fe, Romblon
Purpose of Travel: To attend Division Rabies Quiz Bee and Poster Making Contest.

Date Time Means of ALLOWABLE EXPENSES

(Destination) Dept. Arrival Transpor- Transpor- Meals Lodging Incidental TOTAL
tation tation expense AMOUNT
8/13/2019 Sta. Fe Town 7:30am 7:45am Motorcycle 80.00 80.00
Guinhaya-an 8:00am 8:30am PUJ 50.00 50.00
San Agustin 9:00am 11:00am PUJ 80.00 80.00 200.00 360.00
No trip due to Gale Warning -
8/14/2019 To Romblon pier 4:00am 5:00am ship -
To SDO 7:00am 7:10am Tricycle 10.00 40.00 50.00
pier 12:00nn 12:10nn Tricycle 10.00 40.00 50.00
San Agustin pier 1:00pm 2:00pm ship 100.00 100.00
Guinhaya-an 2:15am 4:00pm PUJ 80.00 80.00
Sta. Fe Town 4:20pm 5:00pm PUJ 50.00 50.00
Residence 5:15pm 5:30pm Motorcycle 80.00 80.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

TOTAL 900.00
I CERTIFY that [1] have reviewed Prepared by:
the foregoing itinerary, [2] the travel is
necessary to the service, [3] the period MARIA LYNETTE A. MOLEÑO

covered is reasonable and [4] the expenses MT-1

claimed are proper. Approved by:

ELJUN F. DELOS REYES ROGER F. CAPA

ESP-1 Schools Division Superintendent
NOTE:
Ang mag cecertify po kapag teacher ang mag ta-travel ay school head
kapag school head naman po ang mag ta-travel ay sir Rufino B. Foz (CHIEF CID / OIC-ASDS)
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IV-B MIMAROPA
Schools Division Office-Romblon
Romblon

CERTIFICATE OF TRAVEL COMPLETED

Date: 2-Sep-19

I certify that I have completed the foregoing itinerary under the condition indicated
below:

X Strictly in accordance with approved itinerary.

Cut short as explained below, additional itinerary amount of P

was refunded om OR No. , dated .

Extended as explained in the itinerary of travel.

Other deviation as explained.

Explanation or Justification: We slept in San Agustion on August 13, 2019 because there
was cancellation of trip going to Romblon due to bad weather.

Evidences of travel attached hereto:

X Certificate of Appearance RER

X Boat/Bus Tickets Locator Slip

X Travel Order
Respectfully yours,

Maria Lynette A. Moleño

MT-1

On evidence and information of which I have knowledge the travel was undertaken.

RUFINO B. FOZ
Officer-In-Charge
Office of the Asst. Schools Division Superintendent

ROGER F. CAPA
Schools Division Superintendent
 REIMBURSEMENT EXPENSE RECEIPT

Date No.
RECEIVED from
Name

the amount of
(Official Designation)
₱
(In words) (In Figures)
in payment for

PAYEE
Name/Signature
Address
Resident Cert. No.
Date of Issue
Place of Issue

WITNESS
Name/Signature
Address
Resident Cert. No.
Date of Issue
Place of Issue
 REQUISITION AND ISSUE SLIP
DEPARTMENT OF EDUCATION
DIVISION OF ROMBLON
SANTA FE- SAN JOSE DISTRICT
ROMBLON

Division ROMBLON Responsibility Center Code: DATE

Office/District:

Requisition Issuan ce
Quantity
Stock No. Unit Description Quantity
1 grams Arina (all purpose flour) 1500 1500
2 grams Bread crumbs 75 75
3 grams Bread white loaf 800 800
4 grams Calamansi juice 150 150
5 grams Cheese 100 100
6 grams Flour Cassava 500 500
7 grams Misua 600 600
8 grams margarine 30 30
9 ml Oil 5000 5000
10 grams Pork cubes 1500 1500
11 ml patis 450 450
12 grams Pepper, ground 100 100
13 grams Pickle relish 150 150
14 grams Raisin 100 100
15 grams Coarse salt 33.3 33.3
16 grams Salt, iodized 450 450
17 ml Soy sauce 220 220
18 grams Chicken cubes 100 100
Purpose: Received materials for SBFP.

Requested by: Approved by:

 Requested by: Approved by:

Signature
Printed Name MARIVIC G. MADRID ELJUN F. DELOS REYES EMY E. MONTOJO
Designation Teacher School Head Property Custodian
Date
Issuan ce
Remarks
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed

Received by:
Received by:

MARIVIC G. MADRID
Teacher