SF-GOOD-59 Ok - 1

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Name of the Procuring Entity

Project Reference Number


Name of the Project
Location of the Project

Standard Form Number: SF-GOOD-59


Revised on: May 24, 2004

Standard Form Title: Purchase Request

PURCHASE REQUEST

_____________________________
Agency / Procuring Entity
Department
Section

STOCK
NO.

PR No.
SAI No.

UNIT

ITEM DESCRIPTION

Date:
Date:

QTY.

UNIT COST

TOTAL COST

Purpose / Remarks: _____________________________________________________


________________________________________________________________
______

_________________________________________________________________________________________

Requested by:
Signature:
Printed Name:
Designation:
Date:

Approved by:

Name of the Procuring Entity

Project Reference Number


Name of the Project
Location of the Project

PURCHASE REQUEST
____________________________________

LGU
PR No.: ____________ Date: _________
SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item
No.

Unit of
Issue

Quantity

Item Description

Estimated
Unit Cost

Estimated
Cost

Purpose:

Requested
by:
Signature:
Printed Name:
Designation:

Cash
availability:

Approved by:

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