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Republic of the Philippines

Department of Health

ZAMBOANGA CITY MEDICAL CENTER


Dr. D. Evangelista St. Sta. Catalina, Zamboanga City, 7000

REQUISITION AND ISSUE SLIP


Division:

Responsibility Center:

RIS No.

Dat

Code:

SAI No.

Dat

Office:

Requisition
Stock No.

Unit

Issuance

Description

Quantity

Quantity

Unit Price

Total Price

Remarks

Purpose:
Requested by:

Approved by:

Issued by:

Received by:

ROMEO A. ONG, MD, MHA


Medical Center Chief II

TERESITA D. ORPIANO
Dental Aide I

Signature:
Printed Name:
Designation:
Date:
ZCMC-F-MM-07

Rev- 0

Effectivity Date: June 2, 2014

Republic of the Philippines


Department of Health

ZAMBOANGA CITY MEDICAL CENTER


Dr. D. Evangelista St. Sta. Catalina, Zamboanga City, 7000

REQUISITION AND ISSUE SLIP


Division:

ADMINISTRATION

Office:

Responsibility Center:

RIS No.

Dat

Code:

SAI No.

Dat

BAC

Requisition
Stock No.

Unit

Issuance

Description

Quantity

ream Book paper short

10

ream Book paper long

10

pcs. Folder long

12

pcs. Folder short

12

pcs. HP Ink CB-4354/35A for Laserjet P1006


box

Paper clip large

Total Price

Remarks

1
4

pcs. Highlighter Pen, yellow

Marking Pen (Black)

pcs. Plastic Adhesive tape 2"

pcs. Plastic Adhesive tape 1"

pcs. Packing tape 2"

spls. Typewritter ribbon black nylon

box

Unit Price

pcs. Battery AA

pc.

Quantity

Staple wire #35

1
x-x-x-x-x-x-x-x-x-x-x-x
nothing follows

Purpose: For BAC office use


Requested by:

Approved by:

Issued by:

Received by:

ROWENA A. ABBILANI
Head, BAC Secretariat

ROMEO A. ONG, MD, MHA


Medical Center Chief II

TERESITA D. ORPIANO
Dental Aide I

ARSENIA R. RANARIO
Bac Secretariat

Signature:
Printed Name:
Designation:
Date:
ZCMC-F-MM-07

11-Nov-14
Rev- 0

Effectivity Date: June 2, 2014

Republic of the Philippines


Department of Health

ZAMBOANGA CITY MEDICAL CENTER


Dr. D. Evangelista St. Sta. Catalina, Zamboanga City, 7000

REQUISITION AND ISSUE SLIP


Division:

ADMINISTRATION

Office:

Responsibility Center:

RIS No.

Dat

Code:

SAI No.

Dat

BAC

Requisition
Stock No.

Unit

Issuance

Description

Quantity

pcs. HP Ink CB-4354/35A for Laserjet P1006

pcs. Plastic Adhesive tape 2"

pcs. Plastic Adhesive tape 1"

pcs. HP Laserjet P1102

Quantity

Unit Price

Total Price

Remarks

x-x-x-x-x-x-x-x-x-x-x-x-x
nothing follows

Purpose: For BAC office use


Requested by:

Approved by:

Issued by:

Received by:

ROWENA A. ABBILANI
Head, BAC Secretariat

ROMEO A. ONG, MD, MHA


Medical Center Chief II

TERESITA D. ORPIANO
Dental Aide I

ARSENIA R. RANARIO
Bac Secretariat

Signature:
Printed Name:
Designation:
Date:
ZCMC-F-MM-07

31-Mar-15

31-Mar-15
Rev- 0

Effectivity Date: June 2, 2014

Republic of the Philippines


Department of Health

ZAMBOANGA CITY MEDICAL CENTER


Dr. D. Evangelista St. Sta. Catalina, Zamboanga City, 7000

REQUISITION AND ISSUE SLIP


Division:
Office:

HOPSS

Responsibility Center:

RIS No.

Dat

Code:

SAI No.

Dat

PROCUREMENT

Requisition
Stock No.

Unit

Issuance

Description

Quantity

pcs. HP Ink CB-4354/35A for Laserjet P1006

pcs. Computer Ink Laserjet 85-a P1102

pcs. Folder Long

Quantity

Unit Price

Total Price

Remarks

20

x-x-x-x-x-x-x-x-x-x-x-x-x
nothing follows

Purpose: For BAC office use


Requested by:

Approved by:

Issued by:

Received by:

ROWENA A. ABBILANI
AO III

ROMEO A. ONG, MD, MHA


Medical Center Chief II

TERESITA D. ORPIANO
Dental Aide I

ARSENIA R. RANARIO
AA III

Signature:
Printed Name:
Designation:
Date:
ZCMC-F-MM-07

April 16, 2015

April 16, 2015


Rev- 0

Effectivity Date: June 2, 2014

Republic of the Philippines


Department of Health

ZAMBOANGA CITY MEDICAL CENTER


Dr. D. Evangelista St. Sta. Catalina, Zamboanga City, 7000

REQUISITION AND ISSUE SLIP


Division:
Office:

HOPSS

Responsibility Center:

RIS No.

Date:

Code:

SAI No.

Date:

PROCUREMENT

Requisition
Stock No.

Unit

Issuance

Description

Quantity

pcs. HP Ink CB-4354/35A for Laserjet P1006

pcs. HP Ink CE285AC for Laserjet P1102

boxes Paper Fastener

Unit Price

Total Price

Remarks

rms

Bond Paper Legal/Long size

rms

Bond Paper A4 size

box

Typewriter ribbon black

box

Jumbo Clips 50mm, 120gms

pcs. Plastic adhesive Tape 1"

pcs. Plastic adhesive Tape 2"

pcs. Masking Tape 2"

box

Quantity

Staple wire #35

pcs. Folder Legal/Long Brown

30

pcs. Folder Letter/Short

20

pcs. Pencil #1

x-x-x-x-x-x-x-x-x-x-x-x-x
nothing follows

Purpose: For BAC office use


Requested by:

Approved by:

Issued by:

Received by:

Designation:

ROWENA A. ABBILANI
AO III

ROMEO A. ONG, MD, MHA


Medical Center Chief II

TERESITA D. ORPIANO
Dental Aide I

ARSENIA R. RANARIO
AA III

Date:

September 01, 2015

Signature:
Printed Name:

ZCMC-F-MM-07

September 01, 2015


Rev- 0

Effectivity Date: June 2, 2014

Republic of the Philippines


Department of Health

ZAMBOANGA CITY MEDICAL CENTER


Dr. D. Evangelista St. Sta. Catalina, Zamboanga City, 7000

REQUISITION AND ISSUE SLIP


Division:
Office:

HOPSS

Responsibility Center:

RIS No.

Date:

Code:

SAI No.

Date:

PROCUREMENT

Requisition
Stock No.

Unit

Issuance

Description

Quantity

units Ink Cartridge for HP Laserjet P1006


unit

Quantity

Unit Price

Total Price

Remarks

Ink Cartridge for HP Laserjet P1002

reams Bond Paper Legal Size 8.5" X 13"

16

reams Bond Paper A4 Size 8.27" X 11.69"

boxes Jumbo Clips 50mm

2
x-x-x-x-x-x-x-x-x-x-x-x-x-x
*** nothing follows ***

Purpose: For BAC office use


Requested by:

Approved by:

Issued by:

Received by:

Designation:

ROWENA A. ABBILANI
AO III

ROMEO A. ONG, MD, MHA


Medical Center Chief II

TERESITA D. ORPIANO
Dental Aide I

ARSENIA R. RANARIO
AA III

Date:

September 01, 2015

Signature:
Printed Name:

ZCMC-F-MM-07

September 01, 2015


Rev- 0

Effectivity Date: June 2, 2014