APR Form Revised March 2007

NAME AND ADDRESS SAMPOLI-B ES, SAMPOLI-B, DIPLAHAN, AGENCY

OF REQUESTING ZAMBOANGA SIBUGAY ACCT. CODE
AGENCY AGENCY CONTROL No.
TEL. NOS.
PS APR No.
AGENCY PROCUREMENT REQUEST

To: THE PROCUREMENT SERVICE November 18, 2021

Department of Budget and Management (Date Prepared)
Zamboanga Sibugay Sub-Depot

PLEASE CHECK (⁄) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

[ ] Please issue common-use supplies/materials per Price List No. _____________________________ dated________________________
Mode of delivery: [ ] Pick-up (Fast Lane) [ ] Pick-up (Schedule) [ ] Delivery (door-to-door)

In case fund is not sufficient: [ ] Reduce Quantity [ ] Bill Us [ ] Charge to Unutilized Deposit, APR No. ____________ Date _________

[ ] Please purchase for our agency non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Others, pls. specify_____________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment _____________________________

IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK HEREOF

ITEM No. ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY Unit Unit Price AMOUNT
1 Plastic Cellophane (Sando Bag) 50 packs 25.00 1,250.00
2 Eco-Bag 50 pcs 20.00 1,000.00
3 Ice Box (Big) 2 pcs 447.00 894.00
4 Travel 4,000.00

7,144.00
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:
WITHIN APPROVED PROGRAM:

SHIRLY V. BARRIOS LORELIE B. YECLA LEONISA V. BRAGANZA

SBFP Coordinator Administrative Assistant II AGENCY HEAD/AUTHORIZED SIGNATURE

[ ] FUNDS DEPOSITED WITH PS [ ] _____________________CHECK No. __________________

IN THE AMOUNT OF: _________________________________________________________________ p
 INSTRUCTIONS / CONDITIONS

AGENCY PROCUREMENT REQUEST (APR)

PS Form No. 001

1.0 This form shall be used/accomplished by agencies for ordering both common use and non-common use
supplies/materials/equipment and shall be submitted to the Agency Servicing Division (ASD). Action desired
should be properly marked on the appropriate box. The APR shall be prepared in five (5) copies with the
Agency Control Number (CAN) clearly indicated in the APR.

2.0 REQUEST must always be prepared SEPARATELY according to the following categories:

2.1 COMMON-USE SUPPLIES, MATERIALS AND EQUIPMENT - refer to those goods, materials
and equipment that are repetitively used in the day-to-day operations of procuring entities in the
peformance of their function. The list of the common use items are found in the Electronic
Catalogue (www.philgeps.net). Hard copy of the Price List is also available at PS-DBM.

2.2 NON-COMMON ITEMS - those that are not classified as common-use supplies and therefore are
not included in the Electronic Catalogue/PS Price List. These are the items peculiar to the needs
of the agency.

3.0 FUNDING: As stated in Section 445.b, paragraph 2 of the Government Auditing and Accounting Manual
(GAAM) and Section 4b paragraph 2 of Executive Order 359: agencies shall remit in advance to the
Procurement Service the funds needed to service their requirement for the supplies, materials and
equipment as reflected in the said Work and Financial Plan/Annual Procurement Program (APP); In case
where outright cash/funds are not available:

3.1 For National Government Agencies (NGAs) - certified true copy of the duly approved Obligation
Request (ObR) shall be submitted together with the APR so that procurement process may be
initiated.

3.2 For Government-Owned and Controlled Corporations (GOCCs), Government Funding Institutions
(GFIs), Local Government Units (LGUs) and State Colleges and Universities (SUCs), the APR
shall be accompanied with the approved corporate budget allocation or certification of funds
availability.

3.3 Upon delivery, the client-agency shall pay PS within five (5) working days after receipt of goods.

4.0 DELIVERY SCHEME

4.1 For common-use supplies/materials and equipment

4.1.1 If items are inteded to be picked-up, the receipt of the APR and payment shall go thru
the Fast Lane and the agency shall receive the goods immediately or within the day
depending on the number of client-agencies lined up to pick-up the goods.

4.1.2 If items are intended to be picked-up on a later date (as scheduled by the agency), the
received APR shall be stamped with the reminder: "Pick-up on (date) ",
thus, the agency shall come back on the scheduled date to pick-up the goods.

4.1.3 For regular deliveries, PS delivers for free within Metro Manila Area. Delivery shall be
done within ten (10) working days after receipt of the APR, partial or complete as
indicated in the Delivery Receipt.

4.1.4 For partial delivery, a Reply Action Document (RAD) is attached to inform agency
regarding the balance as follows:
 - The balance to be served/delivered OR
- The balance not to be served anymore AND
- The amount of remaining/unutilized funds which may be used in the next
request/s or maybe refunded as decided by the agency

5.0 The Procurement Service assumes that requested supplies/materials/equipment are included in the Annual
Procurement Plan (APR) of the agency and that the necessary permit or authority associated with the
request shall be secured by the agency concerned.
APR Form Revised March 2007
NAME AND ADDRESS SAMPOLI-B ES, SAMPOLI-B, DIPLAHAN, AGENCY
OF REQUESTING ZAMBOANGA SIBUGAY ACCT. CODE
AGENCY AGENCY CONTROL No.
TEL. NOS.
PS APR No.
AGENCY PROCUREMENT REQUEST

To: THE PROCUREMENT SERVICE April 12, 2021

Department of Budget and Management (Date Prepared)
Zamboanga Sibugay Sub-Depot

PLEASE CHECK (⁄) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW

[ ] Please issue common-use supplies/materials per Price List No. _____________________________ dated________________________
Mode of delivery: [ ] Pick-up (Fast Lane) [ ] Pick-up (Schedule) [ ] Delivery (door-to-door)

In case fund is not sufficient: [ ] Reduce Quantity [ ] Bill Us [ ] Charge to Unutilized Deposit, APR No. ____________ Date _________

[ ] Please purchase for our agency non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Others, pls. specify_____________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment _____________________________

IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK HEREOF

ITEM No. ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK No. QUANTITY Unit Unit Price AMOUNT
1 travel 1 750.00
2 Bond paper 43 ream 200.00 8,600.00
3 Biscuits 2 pack 60.00 120.00
4 Mineral water 5 bottle 15.00 75.00
5 Epson Ink 1 set 1,718.70 1,718.70
6 Gasoline Unleaded 19 liters 52.63 1,000.00
7 2T oil 2 liters 200.00 400.00
8 nylon #300 1/2 kilo 800.00 400.00
9 Labor 1 month 1,000.00 1,000.00
10 Herbicide 2 quart 500.00 1,000.00
11 Electric Bill 2 month 1,058.31 2,116.62
12 Internet Bill 2 month 1,000.00 2,000.00
13 Mobile phone Load 2 month 1,000.00 2,000.00
14 Smart TV 2 unit 9,000.00 18,000.00
15 Alcohol 10 bottle 100.00 1,000.00
16 Rain or Shine Paint 6 gallon 680.00 4,080.00
17 Labor 4 days 300.00 1,200.00
18 Washable Face Mask 10 pcs 50.00 500.00
19 Face Shield 10 pcs 50.00 500.00
20 Hand Sanitizer 10 bottle 100.00 1,000.00
2 Safeguard 11 box 46.79 514.68

47,975.00
For Pagayon

travel 1 750.00
Bond paper 43 ream 200.00 8,600.00
Biscuits 2 pack 60.00 120.00
Mineral water 5 bottle 15.00 75.00
Epson Ink 1 set 1,718.70 1,718.70
Mobile phone Load 2 month 1,000.00 2,000.00
Alcohol
Rain or 10 bottle 100.00 1,000.00
Shine Paint
Washable 6 gallon 680.00 4,080.00
Face
Face Mask 10 pcs 50.00 500.00
Shield 10 pcs 50.00 500.00
Hand Sanitizer 10 bottle 100.00 1,000.00
Safeguard 11 box 46.79 514.68
nylon #300 1/2 kilo 800.00 400.00
Total for Sir Pagayon 21,258.38
 Outside Expenses 26,716.62

Procurement Service the funds needed to service their requirement for the supplies, materials and
equipment as reflected in the said Work and Financial Plan/Annual Procurement Program (APP); In case
where outright cash/funds are not available:

3.1 For National Government Agencies (NGAs) - certified true copy of the duly approved Obligation
Request (ObR) shall be submitted together with the APR so that procurement process may be
initiated.

3.2 For Government-Owned and Controlled Corporations (GOCCs), Government Funding Institutions
(GFIs), Local Government Units (LGUs) and State Colleges and Universities (SUCs), the APR
shall be accompanied with the approved corporate budget allocation or certification of funds
availability.

3.3 Upon delivery, the client-agency shall pay PS within five (5) working days after receipt of goods.

4.0 DELIVERY SCHEME

4.1 For common-use supplies/materials and equipment

4.1.1 If items are inteded to be picked-up, the receipt of the APR and payment shall go thru
the Fast Lane and the agency shall receive the goods immediately or within the day
depending on the number of client-agencies lined up to pick-up the goods.

4.1.2 If items are intended to be picked-up on a later date (as scheduled by the agency), the
received APR shall be stamped with the reminder: "Pick-up on (date) ",
thus, the agency shall come back on the scheduled date to pick-up the goods.

4.1.3 For regular deliveries, PS delivers for free within Metro Manila Area. Delivery shall be
done within ten (10) working days after receipt of the APR, partial or complete as
indicated in the Delivery Receipt.

4.1.4 For partial delivery, a Reply Action Document (RAD) is attached to inform agency
regarding the balance as follows:

- The balance to be served/delivered OR

- The balance not to be served anymore AND
- The amount of remaining/unutilized funds which may be used in the next
request/s or maybe refunded as decided by the agency

5.0 The Procurement Service assumes that requested supplies/materials/equipment are included in the Annual
Procurement Plan (APR) of the agency and that the necessary permit or authority associated with the
request shall be secured by the agency concerned.