PURCHASE REQUEST

MUNICIPALITY OF TALUSAN
LGU

Department: MO PR No.:____________ Date:_____________

__________________________________ SAI No:____________ Date:_____________
Section: __________________________________ ALOBS No.:_________ Date:_____________

Unit of Estimated Estimated

Item No. Quantity Item Description
Issue Unit Cost Cost
-
1 1 pc TP link TL WN722N 2,000.00 2,000.00
2 1 box Srew sets for Laptop & Desktop 700.00 700.00
3 1 pc HDMI Extension Connector 15 meters 850.00 850.00
Dell Memory Upgrade - 16GB
4 2 pcs 2RX8 DDR4 SODIMM 2400MHz 3,000.00 6,000.00
5 1 box imyfone reseter 3,000.00 3,000.00
6 1 unit External DVD-ROM 1350.00 1,350.00

Total 10,900.00 13,900.00

Purpose: Use for IT Maintenance in LGU

Requested by: Cash Availability: Approved by:

Signature
Printed Name: ORLANDO A. RAMISO, CE, MPA
JEREMIAS J. DAAROL ORLANDO A. RAMISO,CE, MPA
Designation: Municipal Mayor Municipal Treasurer Municipal Mayor
,CE, MPA
 Republic of the Philippines
PROVINCE OF ZAMBOANGA SIBUGAY
Municipality of Talusan

INSPECTION AND ACCEPTANCE REPORT

Supplier : RJT ENTERPRISES IAR No. :
PO No. : Date : Invoice No. : Date :
Requesitioning Office/Department :
Stock No. Unit Description Quantity

1 pc TP link TL WN722N 1
2 box Srew sets for Laptop & Desktop 1
3 pc HDMI Extension Connector 15 meters 1
Dell Memory Upgrade - 16GB
4 pcs 2RX8 DDR4 SODIMM 2400Mhz 2
5 box imyfone reseter 1
6 unit External DVD-ROM 1

INSPECTION
Remarks / Findings : Date Received :
Remarks/Findings :

Recommendation : Recommendation :

INSPECTION COMMITTEE

MARY - ANN R. MAGHANOY

Administrative Assistant III
JOSEPHINE G. MEDEQUILLO
OIC - MPDO
JULIETO G. BACALSO
Revenue Collection Clerk II
ALFREDO R. ANGCAHAN
GSO - D
Name and Signature of Inspection Officers
 Republic of the Philippines
PROVINCE OF ZAMBOANGA SIBUGAY
Municipality of Talusan

No.
DISBURSEMENT VOUCHER
Mode of
Payment Check Cash Others

Payee TIN/Employee No. Obligation Request No.

RJT ENTERPRISES
Responsibility Center
Address Poblacion, Talusan Z.S.P Office/Unit/Project Code

To payment of Supplies use in the office of

Municipal Mayor for IT Maintenance as per supp- 13,325.76
orting documents papers here to attached in the
ammount of THIRTEEN THOUSAND THREE HUNDRED
TWENTY FIVE and 76/100 pesos only.

GROSS: 13,881.00
Less:
Wth
Witholding Tax (13,881.00 x 1%) = 138.81
VAT (13,881.00 x 3%) = 416.43
NET AMOUNT 13,325.76

13,325.76
A. Cetified B.
Allotment obligated for the purpose as indicat Funds Available

Supporting documents complete

Signature Signature
Printed Date Printed Date
Name JORELYN C. EDEM Name JEREMIAS J. DAAROL
Mun. Accountant Position Mun. Treasurer
Position
Head, Accounting Unit/Authorized Representative Treasurer/Authorized Representative
C. APPROVED for Payment D.
Signature Check No. Date
Printed Date Signature
Name Printed Date
ORLANDO A. RAMISO,CE,MPA Name RJT ENTERPRISES
Municipal Mayor OR/Other Documents JEV No. Date
Position
Agency Head/Authorized Representative
 Republic of the Philippines
PROVINCE OF ZAMBOANGA SIBUGAY
Municipality of Talusan
No.
OBLIGATION REQUEST
Payee RJT ENTERPRISES
Office MO
Address POBLACION, TALUSAN, ZSP
ResponsibilParticulars F.P.P. Account Amount
Center Code

To payment of Supplies use in the office of

1011 Municipal Mayor for IT Maintenance as per supp- 1000 5-02-03-010 13,881.00
orting documents papers here to attached in the
ammount of THIRTEEN THOUSAND EIGHT
HUNDRED EIGHTY ONE PESOS ONLY

Total 13,881.00
A. Cetified : B. Certified :

Charges to appropriation/allotment necessary, lawful

and under my direct supervision Exitence of available Appropriation

Supporting documents valid, proper and legal

Signature Signature
Printed Printed
Name ORLANDO A. RAMISO, CE. MPA Name ALEXANDER V. PIDOR
Position Municpal Mayor Position Mun. Budget Officer
Head, Requesting Office/Authorized Representativde Head, Budget Unit/Authorized Representative
Date Date
 REQUISITION AND ISSUE SLIP
MUNICIPALITY OF TALUSAN
LGU
Division: Responsibility Center RIS no. Date:
Office: Code:_______________ SAI No:__________

Requisition Issuance
Stock No. Unit Description Quality Qty. Remarks

1 pc TP link TL WN722N 1
2 box Srew sets for Laptop & Desktop 1
3 pc HDMI Extension Connector 15 meters 1
Dell Memory Upgrade - 16GB
4 pcs 2RX8 DDR4 SODIMM 2400MHz 2
5 box imyfone reseter 1
6 pc External DVD-ROM 1

Purpose: Use for IT Maintenance in LGU

Requested by: Approved by: Issued By: Received by:

Signature: ORLANDO A. RAMISO, CE, MPA ORLANDO A. RAMISO, CE, MPA JEREMIAS J. DAAROL ORLAN
Printed Name: Municipal Mayor MunicipalMayor Municipal Treasurer Municipal Mayor
Designation:
Date: