Scribd
Upload
1 views

PURCHASE REQUEST FORM

The document contains multiple purchase requests from the Philippine Crop Insurance Corporation's Regional Office No. III-A, detailing various items needed for office use and maintenance, including diesel for vehicles and office supplies. Each request includes information such as the entity name, purpose, requested and approved signatures, and fund availability. The requests are organized by date and include specific item descriptions, quantities, and designated approvers.

Uploaded by

pcicro3anl
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
1 views

PURCHASE REQUEST FORM

The document contains multiple purchase requests from the Philippine Crop Insurance Corporation's Regional Office No. III-A, detailing various items needed for office use and maintenance, including diesel for vehicles and office supplies. Each request includes information such as the entity name, purpose, requested and approved signatures, and fund availability. The requests are organized by date and include specific item descriptions, quantities, and designated approvers.

Uploaded by

pcicro3anl
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 10

PURCHASE REQUEST

PHILIPPINE CROP INSURANCE CORPORATION


Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A

Office/Section RO III-A PR No: 2025-01-039


Date: 01/17/25
Section : AFD Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
1 box BlackBag 1
2 bundle Tissue Square 1

XXXNOTHING FOLLOWSXXXX
FUND AVAILABLE:
DATE:______________________

Total -

Purpose: For Office Use/Client

Requested by: Approved by:

Signature Signature
Printed Name MARY GRACE PRINSIPE Printed Name GERLIE R. GREGORIO
Designation SUPPORT SERVICE STAFF Designation OFFICER-IN-CHARGE

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A

Office/Section RO III-A PR No: 2023-05-041


Date: May 29, 2023
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
F/T DIESEL
ISUZU CROSSWIND / SJN 656

Funds Available ____________________


Date _________________

Purpose: OFFICE ERRANDS

Requested by: Approved by:

Signature Signature
Printed Name ARIEL T. SANCHEZ Printed Name MARIO G. LUMIBAO
Designation DRIVER MECH. Designation Officer-in-Charge

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A Fund Cluster:

Office/Section RO III-A PR No: 2023-04-044


Date: April 25, 2023
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
F/T DIESEL

(FORD RANGER Pick-Up 4x4 / SAA - 3032)

Funds Available ____________________


Date _________________

Purpose: OFFICE ERRANDS

Requested by: Approved by:

Signature Signature

Printed Name ARIEL T. SANCHEZ Printed Name MARIO G. LUMIBAO

Designation DRIVER MECH. Designation OIC-REGIONAL MANAGER

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A Fund Cluster:

Office/Section RO III-A PR No:2024-05-


Date: May 7, 2024
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
L DIESEL F/T
(Isuzu D-Max D1S027)
Funds Available ____________________
Date _______________

Purpose: Official Business

Requested by: Approved by:

Signature Signature
Printed Name MARK LORD ELOIM A. VERGARA Printed Name MARIO G. LUMIBAO
Designation J.O Designation OIC-REGIONAL MANAGER

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A Fund Cluster:

Office/Section RO III-A PR No:2025-02-


Date: February 11, 2025
Section : ADMIN AND FINANCE

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
L DIESEL F/T
Toyota Hilux (SND-1936)
XXXNOTHING FOLLOWSXXXX
FUND AVAILABLE:
DATE:______________________

Purpose: Official Business

Requested by: Approved by:

Signature Signature
Printed Name MARK LORD ELOIM A. VERGARA Printed Name GERLIE R. GREGORIO
Designation Job Order Designation OIC-ORM

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A Fund Cluster:

Office/Section RO III-A PR No:2024-11-


Date: November 4, 2024
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
1 pc Air filter 1
Funds Available ____________________
Date _______________

Purpose: Toyota Hilux (SND-1936)

Requested by: Approved by:

Signature Signature
Printed Name MARK LORD ELOIM A. VERGARA Printed Name GERLIE R. GREGORIO
Designation J.O Designation OIC-REGIONAL MANAGER

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A Fund Cluster:

Office/Section RO III-A PR No:2024-04-11


Date: April 2, 2024
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
1 pc 3 Tons hydraulic jack 3
Funds Available ____________________
Date _______________

Purpose: Office vehicle use (pick up)

Requested by: Approved by:

Signature Signature
Printed Name ARIEL T. SANCHEZ Printed Name MARIO G. LUMIBAO
Designation DRIVER MECHANIC B. Designation OIC-REGIONAL MANAGER

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A Fund Cluster:

Office/Section RO III-A PR No:2025-01-


Date: January 14, 2025
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost
L GASOLINE F/T
(Honda BR-V SAB-4881)
Funds Available ____________________
Date _______________

Purpose: Office Errands

Requested by: Approved by:

Signature Signature
Printed Name MARK LORD ELOIM A. VERGARA Printed Name GERLIE R. GREGORIO
Designation J.O Designation OIC-REGIONAL MANAGER

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A

Office/Section RO III-A PR No: 2023-06-


Date: June 5, 2023
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost

Purpose: OFFICE GROUNDS MAINTENANCE

Requested by: Approved by:

Signature Signature
Printed Name ARIEL T. SANCHEZ Printed Name MARIO G. LUMIBAO
Designation DRIVER MECH. Designation Officer-in-Charge

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File
PURCHASE REQUEST
PHILIPPINE CROP INSURANCE CORPORATION
Regional Office No. III-A
Cabanatuan City

Entity Name: PCIC RO III-A

Office/Section RO III-A PR No: 2023-06-


Date: June 5, 2023
Section : ADMIN AND FINANCE Responsibility Center Code: ____

Stock Unit Item Description Quantity Unit Cost


No. Total Cost

Purpose: OFFICE GROUNDS MAINTENANCE

Requested by: Approved by:

Signature Signature
Printed Name ARIEL T. SANCHEZ Printed Name MARIO G. LUMIBAO
Designation DRIVER MECH. Designation Officer-in-Charge

Accomplish in 3 copies Copy 1 Original Copy 2 Supply or Porperty Div/Unit File Copy 3 Requisitioning DeptDivision File

You might also like