Republic of the Philippines

Department of Education
Region V
SCHOOLS DIVISION OF ALBAY
Lignon Hill, Bogtong, Legazpi City
Telefax: (052) 481-5939. Website: www.depedalbay.com.ph

Fund Cluster:
101101
101407
DISBURSEMENT VOUCHER 104102

Date:
DV No:

Mode of
MDS Check Commercial Check ADA Others(Please specify)
Payment

TIN/Employee NO.: 266-929-249 ORS/BURS No.

Payee
FAITH'S GENERAL MERCHANDISE

Address
Pioduran, Albay
Particulars Responsibility Center MFO/PAP Amount

To payment for the purchase of goods/supplies

for the School-Based Feeding Program (SBFP) of

Tibabo Elementary School per supporting papers

hereto attached, amounting to…

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

ALMA M. OSIA
Printed Name, Designation and Signature of Supervisor

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D Approved for Payment

Cash available
Subject to Authority to Debit Account ( when applicable)
Supporting documents complete and amount claimed proper

Signature Signature

Printed Name JOSEPH O. NOBLEZA Printed Name ALMA M.OSIA

Position School Bookkeeper Position TEACHER IN-CHARGE

Date 12/18/2020 Date 12/18/2020

E. Receipt of Payment JEV No.:
Check/ADA Date Bank Name & Account Number:
NO.:

Signature: Date: 12/18/2020 Printed Name: REYNANTE M. PALIMA Date:

Official Receipt No. & Date/Other Documents

 Department of Education
Schools Division of Albay
PIODURAN WEST DISTRICT
TIBABO ELEMENTARY SCHOOL

PURCHASE REQUEST

Department : ____________________________ PR No.: _________ Date : _________________

Section : ________________________________ SAI No._________ Date : _________________
ALOBS: ________ Date : _________________

Unit of Estimated
Quantity Item Description Stock No. Estimated Cost
Measure Unit Cost

129 pcs Apple 18.00 2,322.00

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-
-
-
-
-
-
-
-
-
-

PHP 2,322.00
Purpose

Requested by: Approved by:

Signature :
Printed Name : JORGE R. REBANAL ALMA M. OSIA
Designation : School Supply Officer Teacher In-Charge
 Department of Education
Schools Division of Albay
PIODURAN WEST DISTRICT
TIBABO ELEMENTARY SCHOOL

PURCHASE ORDER
Supplier: Faith's General Merchandise P.O No. : ________________________________
Address: Pio Duran, Albay Date : ________________________________
TIN: Mode of Procurement : Shopping

Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery :Tibabo ES Delivery Term: ________________

Date of Delivery : ______________________________ Payment Term: COD
Stock No. Unit Description Quantity Unit Cost Amount
1 pcs Apple 129 18.00 2,322.00
-
-
-
-
-
-
-
-
-
-
-

(Amount in Words) PHP 2,322.00

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,

ALMA M. OSIA
Teacher In-Charge
Conforme:
REYNANTE M. PALIMA
Signature over Printed Name of Supplier
_____________________
(Date)

ALOBS No.
Amount
 Department of Education
Division of Albay
School : TIBABO ELEM. SCHOOL
(Name of School)
ABSTRACT OF QUOTATION
Project : PR/RIS/JO No. : < type here >
Purpose : Date : < type here >

UNIT PRICE QUOTED BY CORRESPONDING BIDDERS

Item No. Articles Imhiaw’s Catering Services,
Faith’s General Merchandise Palmor’s Store
Bakery & Snack House
1 Regular Size Apple 18.00 18.00 18.00

CERTIFICATE OF COMMITTEE ON BID AWARDS

Based on Abstract of Price Quotations offered by dealers on various materials
as quoted above, this COMMITTEE, considering the lowest reasonable price,
hereby make the following awards.

Above item awarded to ____________________________________________.

DONE in this Office this ______________________________.

CHRISTY P. MUELLA JOSEPH O. NOBLEZA CHERRY O. OLAGUERA

Regular Member Chairman Regular Member

CRISANTA R. BARIZO MA. FRANCIA N. BULACAN

Provisionary Member Provisionary Member

WITNESS TO OPENING BID ONLY:

 Department of Education
Division of Albay
Schools Division Office of Albay
Pioduran West District
TIBABO ELEMENTARY SCHOOL

CERTIFICATION

This is to certify that the items procured per Purchase Order No. _____, dated _________ are all
included in the school Approved Annual Procurement Plan (APP) for Calendar Year 2020.

Issued this _______day of ___________ , 2020 in support for the payment to be made for the
cost of items delivered by the supplier dated _________________________.

COMMITTEE ON BIDS AND AWARDS

CHRISTY P. MUELLA JOSEPH O. NOBLEZA CHERRY O. OLAGUERA

Regular Member Chairman Regular Member

CRISANTA R. BARIZO MA. FRANCIA N. BULACAN

Provisionary Member Provisionary Member
 Republic of the Philippines
Department of Education
Region V
Division of Albay
School : TIBABO ELEM. SCHOOL
(Name of School)

Date : _______________

The Inspectorate Team

School _____________________
Address ___________________

Sir/Madam:

I have the honor to request your team to inspect as to quantity and specification the delivered
supplies/materials made by ____________________________________ per Delivery Receipt No. __________
dated _____________________________, purchased under Purchase Order No. ___________________ dated
____________________________ hereto attached for your perusal.

Thank you.

Very truly yours,

JORGE R. REBANAL
Supply Officer-Designate

Received:

CHRISTY P. MUELLA
Inspectorate Team Leader/Member
 INSPECTION AND ACCEPTANCE REPORT

Entity Name: Department of Education - AMD Fund Cluster : OSEC

Supplier: IAR No. :

PO No./Date: Date :
Requisitioning Office/Dept. : AMD Invoice No.
Responsibility Center Code : __________________

Stock/ Description Unit Quantity/Cost/Total Amount

Property
1 Regular Size Apple pc 86/18.00/1,548.00

TOTAL AMOUNT Php 1,548.00

Date Inspected: Date Received:

Inspected, verified and found in order Complete

as to quantity and specifications
Partial (pls. specify quantity)
CHRISTY P. MUELLA
Inspection Officer/Inspection Committee

CRISANTA R. BARIZO
Inspection Officer/Inspection Committee

CHERRY O. OLAGUERA JORGE R. REBANAL

Inspection Officer/Inspection Committee Supply and/or Property Custodian
 INSPECTION AND ACCEPTANCE REPORT

Entity Name: Department of Education - AMD Fund Cluster : OSEC

Supplier: IAR No. :

PO No./Date: Date :
Requisitioning Office/Dept. : AMD Invoice No.
Responsibility Center Code : __________________

Stock/ Description Unit Quantity/Cost/Total Amount

Property
1 Regular Size Apple pc 43/18.00/774.00

TOTAL AMOUNT Php 774.00

Date Inspected: Date Received:

Inspected, verified and found in order Complete

as to quantity and specifications
Partial (pls. specify quantity)
CHRISTY P. MUELLA
Inspection Officer/Inspection Committee

CRISANTA R. BARIZO
Inspection Officer/Inspection Committee

CHERRY O. OLAGUERA JORGE R. REBANAL

Inspection Officer/Inspection Committee Supply and/or Property Custodian
 Appendix 63
REQUISITION AND ISSUE SLIP

Entity Name: ________________________ Fund Cluster: _____________________

Division: ALBAY Responsibilty Center Code: ___________________
Office: TIBABO ES RIS No.: __________________________________
Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity Remarks
1 pc Regular Size Apple 43 ✓ 43 Complete

Purpose: SBFP 2020

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

Signature:
Printed Name: CHERRY O. OLAGUERA ALMA M. OSIA JORGE R. REBANAL CHERRY O. OLAGUERA
Designation: Teacher I School Principal I Sch. Prop. Custodian Teacher I
Date:

Appendix 63
REQUISITION AND ISSUE SLIP

Entity Name: ________________________ Fund Cluster: _____________________

Division: ALBAY Responsibilty Center Code: ___________________
Office: TIBABO ES RIS No.: __________________________________
Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity Remarks
1 pc Regular Size Apple 86 ✓ 86 Complete

Purpose: SBFP 2020

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

Signature:
Printed Name: CHERRY O. OLAGUERA ALMA M. OSIA JORGE R. REBANAL CHERRY O. OLAGUERA
Designation: Teacher I School Principal I Sch. Prop. Custodian Teacher I
Date: