Appendix 60

PURCHASE REQUEST

Entity Name: _______________________ Fund Cluster: __________________

Office/Section : _____________ PR No.: ______________ Date: ____________

_________________________ Responsibility Center Code : ___________

Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.

Purpose: ____________________________________________________________
_______________________________________________________________
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : _________________________ ___________________________
Designation : _________________________ ___________________________

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 PURCHASE REQUEST

Entity Name: DMMMSU-Open University System Fund Cluster: _________________

Office/Section : _____________ PR No.: ______________ Date: ____________
_________________________ Responsibility Center Code : ___________
Stock/ Property
No. Unit Item Description Quantity Unit Cost Total Cost
pcs Canon Ink-Black 5
pcs Canon Ink-Colored 5
pcs Flashdrive (16gb) 2
pcs Whiteboard Marker (black) 3
pack Tissue (2 ply) 3
pc Extension (3 meters) 1

Purpose: ___________________________________________________________
For COA-DMMMSU Use (3rd Qtr 2016)
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : May Angelica Manzano Teneza Ophelia RL A. Cardenas
Designation : State Auditor II Director
 PURCHASE REQUEST

Entity Name: DMMMSU - MID LA UNION CAMPUS Fund Cluster: _________________

Office/Section : DMMMSU-COA PR No.: ______________ Date: July 15, 2016
_________________________ Responsibility Center Code : ___________
Stock/ Property
No. Unit Item Description Quantity Unit Cost Total Cost
pc Printer 1
specifications:
3 in 1 printer (Print, Scan, Copy)
pcs 4 Port USB Hub 3

Purpose: ___________________________________________________________
For COA-DMMMSU Use 2016

Requested by: Approved by:

Signature : _________________________ ___________________________
Paulito C. Nisperos
Printed Name : Marlino P. Estacio
Designation : ATL- Chancellor
 PURCHASE REQUEST

Entity Name: DMMMSU Fund Cluster: __________________

Office/Section : COA - DMMMSU PR No.: ______________
Responsibility Center Code : Date: Feb. 5, 2016
_________________________ ___________
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
pcs Morocco Folder - Blue 30
pcs Acetate 30
ream Long Bond Paper 5
ream Short Bond Paper 5

Purpose: ___________________________________________________________
For COA-DMMMSU Use
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : Joanna Eden Rose Chua-Abriam Jaime I. Manuel, Jr.
Designation : State Auditor I Chancellor
 PURCHASE REQUEST

Entity Name: _______________________ Fund Cluster: __________________

Office/Section : _____________ PR No.: ______________ Date: ____________
_________________________ Responsibility Center Code : ___________
Stock/ Property
No. Unit Item Description Quantity Unit Cost

Purpose: ___________________________________________________________
For COA-DMMMSU Use
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ __________________________
Printed Name : May Angelica Manzano-Teneza Inocencio Mangaoang
Designation : State Auditor II Chancellor
______
Date: ____________

Total Cost

___
 PURCHASE REQUEST

Entity Name: DMMMSU - CENTRAL ADMIN. Fund Cluster: __________________

Office/Section : COA - DMMMSU PR No.: ______________
Responsibility Center Code : Date: Feb. 5, 2016
_________________________ ___________
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
pcs Morocco Folder - Blue 30
pcs Acetate 30
ream Long Bond Paper 10
ream Short Bond Paper 5

Purpose: ___________________________________________________________
For COA-DMMMSU Use
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : Joanna Eden Rose Chua-Abriam Atty. Benjamin S. Sapitula
Designation : State Auditor I President

PURCHASE REQUEST

Entity Name: DMMMSU - CENTRAL ADMIN. Fund Cluster: __________________

Office/Section : COA - DMMMSU PR No.: ______________
Responsibility Center Code : Date: Feb. 5, 2016
_________________________ ___________
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
ream Bond paper (long)
pcs Canon Ink (black)
pcs Canon Ink (colored)
Folder (regular) long
Folder (expanded)long
Scotch tape
pcs White glue (with applicator)
Purpose: ___________________________________________________________
For COA-DMMMSU Use
_______________________________________________________________

Requested by: Approved by:

Signature : _________________________ ___________________________
Printed Name : Joanna Eden Rose Chua-Abriam Atty. Benjamin S. Sapitula
Designation : State Auditor I President
 PURCHASE REQUEST
DMMMSU CENTRAL ADMINISTRATION
Department: COMMISSION ON AUDIT PR NO. ________________ Date: 10/23/2017
SAI No. ________________ Date: _____________
Section: Commission on Audit (COA) ALOBS No. _____________ Date: _____________

Qty. Unit Item Description Stock No. Unit Cost Total Cost
10 pcs Collapsible Portable Storage box
5 pcs scotch tape (1")
5 pcs scotch tape (2")
10 pcs canon black ink (810)
5 pcs canon colored ink (811)
1 box permanent marker (black-broad)
5 box steel fastener
1 box sign pen (red)
1 box sign pen (black)
2 bottles air freshener (ocean escape scent)
2 bottles air freshener (lavander)
10 bottles alcohol
10 reams bond paper (short)
5 reams bond paper (long)
1 pack morocco folder (blue)
5 packs sign here post it flags (assorted colors - 1/2" wide)
1 pack sticker paper
1 pack acetate
3 packs tissue paper

Purpose: For COA Office use only

Requested by: Approved by:

Signature:
Printed Name: MAY ANGELICA M. TENEZA BENJAMIN P. SAPITULA
Designation: State Auditor II President