___________________________________________________________________________________

PURCHASE REQUEST
No. _____________________
Date: ___________________
_________________________________________________________________________________________________________
TO: Mr. WALTER L. TRASPE
(OIC) Municipal Treasurer
Nampicuan, Nueva Ecija
___________________________________________________________________________________________________________________________________

Delivery/Shipment to:

LGU – Nampicuan, Nueva Ecija Period of delivery:______________________

Item
No. QTY. UNIT DESCRIPTION ESTIMATED QUANTITY
COST/UNIT
In ON
Proc. HAND
1. 29 packs PANCIT MALABON
2. 29 packs SOPAS WITH PUTO
3. 29 packs KALAMAY
4. 9 packs CROSSINI BISCUIT x10’s
5. 87 bottle C2 SOLO
6. 174 bottle REFRESH MINERAL WATER 350ML
7. 29 packs LUNCH (RICE, F. CHICKEN,VEGES)
8. 29 packs LUNCH (RICE, F. TILAPIA, VEGES)
9. 29 packs LUNCH (RICE, MENUDILLO,VEGES)
10. 2 packs BREAKFAST (PORKSILOG)
11. 2 packs BREAKFAST (LONGSILOG)
12. 4 packs DINNER (RICE, MEAT VIAND,VEGES)
13. 8 sachet 3 IN 1 NESCAFE TWINPACK
14. 23 pcs LONG PLASTIC ENVELOPE
15. 23 pcs BALL PEN
16. 4 pcs MANILA PAPER
17. 4 pcs PERMANENT MARKER BLACK
18. 3 packs TOKEN
19. 2 way TRANSPORTATION ALLOWANCE (RENTAL)
I hereby certify that the foregoing description to be procure/purchase is necessary for the Municipality
of Nampicuan, Nueva Ecija in connection with the following activity/project.

Requested by: Approved:

MICA JOY E. DISQUITADO,MD VICTOR M. BADAR

(Head of Department/Office) Local Chief Executive
___________________________________________________________________________________________________________________________________

CERTIFICATION

(1) Appropriations (2) Estimated Expenditures (3) Funds Available:

Available: Obligated:

ROGELIO D. GARCIA, JR. ARIES P. ILDEFONSO WALTER L. TRASPE

Budget Officer Municipal Accountant (OIC) Municipal Treasurer

FROM WHOM PURCHASED Order Quantity Cost Unit

Number Date
 PURCHASE ORDER
Nampicuan, Nueva Ecija

Supplier: _______________________ P.O. No. ________________________

Date: _________________________
Address: _______________________ Mode of Procurement ___________
P.R. No. _________________________

Sir/Madam;

Please furnish this office the following articles subject to the terms and conditions contained herein

Place of Delivery: _______________________________ Delivery Term: ___________________

Date Of Delivery: ______________________________ Payment Term: __________________
Item
No. Qty. Unit Description Unit Price Amount

1. 29 packs PANCIT MALABON

2. 29 packs SOPAS WITH PUTO
3. 29 packs KALAMAY
4. 9 packs CROSSINI BISCUIT x10’s
5. 87 bottle C2 SOLO
6. 174 bottle REFRESH MINERAL WATER 350ML
7. 29 packs LUNCH (RICE, F. CHICKEN,VEGES)
8. 29 packs LUNCH (RICE, F. TILAPIA, VEGES)
9. 29 packs LUNCH (RICE, MENUDILLO,VEGES)
10. 2 packs BREAKFAST (PORKSILOG)
11. 2 packs BREAKFAST (LONGSILOG)
12. 4 packs DINNER (RICE, MEAT VIAND,VEGES)
13. 8 sachet 3 IN 1 NESCAFE TWINPACK
14. 23 pcs LONG PLASTIC ENVELOPE
15. 23 pcs BALL PEN BLACK
16. 4 pcs MANILA PAPER
17. 4 pcs PERMANENT MARKER BLACK
18. 3 packs TOKEN
19. 2 way TRANSPORTATION ALLOWANCE (TRICYCLE RENTAL)

TOTAL AMOUNT (In words): PESOS ONLY

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,

WALTER L. TRASPE
(OIC) Municipal Treasurer
CONFORMED:
____________________
Firm/Supplier/Dealer/Contractor

_________________________
Signature over printed name

___________________
Date
 Republic of the Philippines
Province of Nueva Ecija
MUNICIPALITY OF NAMPICUAN
-oOo-
DISBURSEMENT VOUCHER No.

Mode of
Payment x Check Cash Others
TIN/Employee No. Obligation Request No.
Payee BRIGIDA E. GUARDION
Responsibility Center
Address
RHU – Nampicuan, Nueva Ecija Office/Unit/Project: Code

EXPLANATION AMOUNT

TO CASH ADVANCE for the expenses of BARANGAY NUTRITION SCHOLAR BASIC

COURSE TRAINING as per supporting papers hereto attached, amounting to THIRTEEN
Php 13,700.00
THOUSAND SEVEN HUNDRED PESOS ONLY. . . . . . . . . . . . . . . . . . .

A. Certified: B. Certified:
Allotment obligation for the purpose above

Supporting document complete Funds Available

Signature Date Signature Date

Printed Printed
Name Name
ARIES P. ILDEFONSO WALTER L. TRASPE
Position Position
Municipal Accountant (OIC) Municipal Treasurer
Head, Accounting Unit/Authorized Representative Treasurer/Authorized Representative

C. Approved for Payment D. Received Payment

Check No. Bank Name Date

Signature Date Signature

Printed Printed
Name Name
Position BRIGIDA E. GUARDION
VICTOR M. BADAR Payee
Municipal Mayor OR/Other Documents JEV No. Date
Agency Head/Authorized Representative

JOURNAL ENTRY VOUCHER Date:

No. :

Collection Check Disbursement Cash Disbursement Others

Responsibility Account
Center Accounts and Explanation Code Ref Amount

Debit Credit

Approved by:

ARIES P. ILDEFONSO
Municipal Accountant
 Republic of the Philippines
Province of Nueva Ecija
Municipality of Nampicuan
-oOo-

OBLIGATION REQUEST No.

Payee BRIGIDA E. GUARDION

Address: Nampicuan, Nueva Ecija

Office: RHU – Nampicuan, Nueva Ecija

Responsibility PARTICULARS FPP Account Amount
Center
Code

TO CASH ADVANCE for the expenses of BARANGAY Php 13,700.00

NUTRITION SCHOLAR BASIC COURSE TRAINING as
per supporting papers hereto attached, amounting
to THIRTEEN THOUSAND SEVEN HUNDRED PESOS
ONLY. . . . . . . . . . . . . . . . . . .

THIRTEEN THOUSAND SEVEN HUNDRED PESOS ONLY. . . . . . . . . . . . . . . . . . Php 13,700.00

Certified: A. Certified:
Charges to appropriation/statement necessary lawful
and under my direct supervision
Existence of available appropriation
Supporting documents; valid, proper and legal

Signature Signature

Printed Name MICA JOY E. DISQUITADO, M.D. Printed Name

ROGELIO D. GARCIA, JR.
Position Municipal Health Officer Position Municipal Budget Officer
Head, Requesting Officer/Authorized Representative Head, Budget Unit/Authorized Representative

Date Date
 Date:
ITINERARY OF TRAVEL
Name: Position: MNAO Monthly Salary
MARIA LEOWELLA R. ORCINO

Official Station: RHU NAMPICUAN Residence:

Nampicuan, Nueva Ecija

Purpose of Travel:
Marketing of items for Nutrition Month Celebration
Time Allowable Expenses
Means of
Date: Place/s to be visited Arrival to Departure Transportation Trans. Incidental
Place of from Place of Expenses
Dest. Meals Expenses/ Total
Destination Allowance
/Toll Fee
October
19,2017 Paniqui, Tarlac Tricycle 200.00 200.00
Rental

Back to official station-

Nampicuan, Nueva
Ecija

200.00

Breakdown of Expenses:
Transportation-Toll Fees 200.00
Meal
Incidental Expenses
Training/Seminar/Registration Fee

TOTAL ALLOWABLE EXPENSES: PHP 200.00

Prepared by: (Official /Employee)

I certify that (1) I have reviewed the foregoing itinerary (2)
The travel is necessary to the service (3) The period covered MARIA LEOWELLA R. ORCINO
is reasonable and (4) expenses claimed are proper. Employee

Approved:

VICTOR M BADAR
Municipal Mayor