Republic of the Philippines

Department of Health
Regtional Office IV-A (CALABARZON)
TREATMENT AND REHABILITAION CENTER
Tagaytay City

PURCHASE REQUEST
Department: Residential / Inpatient PR No. Date: 2/27/2018
Section: SAI No. ________________________Date:
Stock No. Unit Item Description Quantity Unit Cost Total Cost
1 pck Tang (Orange ) Instant drink mix (525g) 3 168.00 504.00
2 pck La pacita Graham Cracker Sandwich (125g) 3 26.25 78.75
4 pck Comby Creamy Choco 28 43.50 1,218.00
5 Box Fibisco Butter Crunch Cookies (600g) 1 140.75 140.75
6 Box Fibisco Peanut Crunch Cookies (600g) 1 143.75 143.75
7 Box Fibisco Chocolate Chip Cookies (600g) 1 166.50 166.50
8 pck Lemon Square Assorted 2 53.75 107.50
9 pck Ding Dong 5 17.75 88.75
10 pck Happy 5 17.75 88.75
11 pck Sugo 5 18.00 90.00

Purpose: For Program Use

CC
Requested By: Approved By:
Signature:
Printed Name: MHADIA N. ABUSAMAN,RPm,MPA Ronnie C. Del Mundo, MD, MPA, FPCAM
Designation: Dorm Manager III/HPO Chief of Hospital III
 Republic of the Philippines
Department of Health
Regtional Office IV-A (CALABARZON)
TREATMENT AND REHABILITAION CENTER
Tagaytay City

PURCHASE REQUEST
Department: Residential / Inpatient PR No. Date: 2/27/2018
Section: SAI No. _____________________Date:
Stock No. Unit Item Description Quantity Unit Cost Total Cost
1 pc Tarpaulin (3X6) 1 360.00
2 pc AVT Certificate Holder 5 45.75
3 pax snacks for participants 80 35.00

Purpose: For Program Use

Requested By: Approved By:

Signature:
Printed Name: MHADIA N. ABUSAMAN,RPm,MPA Ronnie C. Del Mundo, MD, MPA, FPCAM
Designation: Dorm Manager III/HPO Chief of Hospital III
 Republic of the Philippines
Department of Health
Regtional Office IV-A (CALABARZON)
TREATMENT AND REHABILITAION CENTER
Tagaytay City

PURCHASE REQUEST
Department: Administrative PR No. Date: 12/5/2016
Section: SAI No. ________________________ Date:
Stock No. Unit Item Description Quantity Unit Cost Total Cost
1 lot Janitorial Services 1 Lot 816,000.00

Purpose: To provide four (4) janitors for a period of one (1) year

Requested By: Approved By:

Signature:
Printed Name: Atty. Timoteo P. Pineda, Jr. Ronnie C. Del Mundo, MD, MPA, FPCAM
Designation: Chief Administrative Officer Chief of Hospital III
 Republic of the Philippines
Department of Health
Regtional Office IV-A (CALABARZON)
TREATMENT AND REHABILITAION CENTER
Tagaytay City

PURCHASE REQUEST
Department: Residential / Inpatient PR No. Date:
Section: SAI No. ________________________ Date:
Stock No. Unit Item Description Quantity Unit Cost
1 pc Tarpaulin (3X6) 1 360.00
2 pc AVT Certificate Holder 5 45.75
3 pax snacks for participants 80 35.00

Purpose: Snacks and instructional materials for the socialization "My Life's Masterpiece Repainting Life
towards a Successful Recovery" on February 28, 2018 at the DOH TRC Multi Purpose Hall.
Requested By: Approved By:
Signature:
Ronnie C. Del Mundo, MD, MPA,
Printed Name: MHADIA N. ABUSAMAN,RPm,MPA
FPCAM
Designation: Dorm Manager III/HPO Chief of Hospital III
 Republic of the Philippines
Department of Health
Regtional Office IV-A (CALABARZON)
TREATMENT AND REHABILITAION CENTER
Tagaytay City

PURCHASE REQUEST
Department: Residential / Inpatient PR No. Date: 4/8/2019
Section: SAI No. _____________________ Date:
Stock No. Unit Item Description Quantity Unit Cost Total Cost

1 lot Notarization of Contract of Service 1 250.00

Purpose: For Program Use

Requested By: Approved By:

Signature:
Printed Name: MHADIA N. ABUSAMAN,RPm,MPA Ronnie C. Del Mundo, MD, MPA, FPCAM
Designation: Dorm Manager III Chief of Hospital III