Reference No.: OMSC-Form-CAO-03 Effectivity Date: November 06, 2017 Revision No.

: 00

Republic of the Philippines

OCCIDENTAL MINDORO STATE COLLEGE
Admin Bldg., Labangan Poblacion, SJOM
Website: www.omsc.edu.ph Email Address: omsc_9747@yahoo.com
Tele/Fax: (043) 457-0231

Date:

SUPPLIES/MATERIALS/EQUIPMENT/SERVICES REQUEST FORM

College/Office/Campus:

Purpose:

PARTICULARS UNIT QUANTITY UNIT PRICE TOTAL PRICE

GRAND TOTAL -

Funding Source/Code: Php ________________

Requested supplies/materials/equipment/services are included in my approved procurement plan for FY ___________

and are necessary, lawful and will be under my direct supervision as requesting party. Specification and prices have
been reviewd and revalidated by the undersigned.

Note 1: Responsibility for lawfulness and necessity of transaction rests on the Head of the end-user unit pursuant to
the Government Accounting Manual (GAM);

Requested by:

VPAA/VPAFSS/DEANS/CAMPUS DIRECTOR/UNIT HEADS VPAA/VPAFSS

DIRECTOR OF RESEARCH AND EXTENSION/
Contact Number: ___________________

:Action Taken SUC President Office

Approved□
:Disapproved Remarks□
______________________________

MARLYN G. NIELO, PhD

SUC PRESIDENT II

Monitoring/Notification of result:
: _____________________Date Received
:Recorded Remarks□ : _____________________CAO Office Reference Number
____________________________ : ______________Date Forwarded to the SUC President
MA. PAZ FATIMA D. PALMARES, CPA
: ___________________Date Returned to the Requester
CHIEF ADMINISTRATIVE OFFICER

Copy Furnished: Concerned Officials