Republic of the Philippines

Department of Education
Caraga Administrative Region
DIVISION OF AGUSAN DEL NORTE
Butuan City

PURCHASE ORDER

Supplier: __________________________________________________ P.O. No: __________________________________________________

Address: __________________________________________________ Date: __________________________________________________
TIN: __________________________________________________ Mode of Procurement: _______________________________________

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

Place of Delivery: A. BELTRAN ELEM. SCHOOL Delivery term: ________________________________________

Date of Delivery: Payment Term: CASH

Stock / Property Unit Description Quantity Unit Cost Amount

Number
1 sack Rice 5 2,300.00 11,500.00
2 kls. Fish 31 150.00 4,650.00
3 kls. Chicken 35 160.00 5,600.00
4 kls. Pork 25 180.00 4,500.00
5 kls. Eggs 6 190.00 1,140.00
6 kls. Vegetable assorted 40 50.00 2000.00
7 kls. Monggo 10 80.00 800.00
8 kls. Cooking oil 6 60.00 360.00
9 liter Vinegar 8 31.00 248.00
10 kls. Toyo 15 45.00 675.00
11 kls. Salt 4 30.00 120.00
12 kls. Misua 20 30.00 600.00
13 pack Cocoa 16 58.00 928.00
14 pack Sugar 12 40.00 480.00
15 kls. Ripe banana 40 20.00 800.000
16 kls. Melon 35 30.00 1,050.00
17 pack Lumpia wrapper 10 20.00 200.00
18 gal Purified drinking water 20 40.00 800.00
19 kls. Spices 5 122.20 611.00
-
-
-
-
-
(Total Amount in Words) Thirty Seven Thousand Sixty Two Pesos 37,062.00
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 on the undelivered item/s.

Conforme: Very truly yours,

___________________________________________ BETTY D. BERMUDEZ

Signature over Printed Name of Supplier Signature over Printed Name of Supplier of Authorized Official

___________________________________________ School Head

Date Designation
Fund Cluster: ORS/BURS No.:
Funds Available: Date of ORS/BURS:
Amount:

School Budget Officer

 Republic of the Philippines
Department of Education
Caraga Administrative Region
DIVISION OF AGUSAN DEL NORTE
Butuan City

ORS No.:

OBLIGATION REQUEST AND STATUS ORS No.:

Date:
Fund Cluster:

Payee: BETTY D. BERMUDEZ

Office: A. BELTRAN ELEMENTARY SCHOOL

ADDRESS: A. BELTRAN, JABONGA, AGUSAN DEL NORTE
RESPONSIBILITY PARTICULARS MFO/PAP UACS OBJECT AMOUNT
CODE
CENTER

7010816001 TO REIMBURSE EXPENSES OF SCHOOL-BASED FEEDING 302050002 520503000 37,062.00

PROGRAM FOR 29 DAYS IN THE AMOUNT OF.

TOTAL 37,062.00

A. Certified: B. Certified:
Charges to appropriation/ allotment are necessary, lawful and Allotment available and obligation for the
under my direct supervision; and supporting documents valid, proper and purpose/adjustment
legal
Necessary as indicated above

Signature:
Signature:
Printed Name: BETTY D. BERMUDEZ
Printed Name: DAYLINDA T. SALUBLE
Position: School head
Position: Budget Officer
Date:
Date:

C. STATUS OF OBLIGATION

REFERENCE AMOUNT

DATE PARTICULARS ORS/JEV/CHECK/ADA/TRA OBLIGATION PAYABLE PAYMENT BALANCE

No.
NOT DUE AND
YET DEMANDABLE
DUE