General Form No.
REQUISITION AND ISSUE SLIP
BARANGAY PALSONG
Agency
Division: Responsibility Center Code RIS No:
Office: SAI No.
Requisition Issuance
Stock No. Unit Description Quantity Quantity Remarks
Purpose:
Requedted by: Approved by: Issued by: Received by:
ANNIE E. SERNAL DOMINGO P. SEPAGAN _______________________ ANNIE E. SERNAL
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Baranagay Treasurer Punong Baranagy Baranagay Treasurer
Dessignation Dessignation Dessignation Dessignation
Date: ________________ Date: ________________ Date: ________________ Date: ________________
Republic of the Philippines
Province of Camarines Sur
Municipality of Bula Barangay PALSONG
Office of the Punong Barangay
Office No. 0947-184-69681
REPORT OF OFFICIAL TRAVEL
Type of Vehicle
SGB 820
DATE DESTINATION FUEL GREASE PURPOSE OF TRAVEL
CONSUMED
01-11-2024 LANDBANK, NAGA CITY 7.633 INCASH
01-17-2024 NAGA CITY 9.47 CANVASS UNIFORM
I HEREBY CERTIFY to the correctness of above information and that the use of the subject Vehicles
RICHARD H. ESPALMADO
DRIVER
Prepared by:
ANNIE E. SERNAL
BRGY. TREASURER
Republic of the Philippines
Province of Camarines Sur
Municipality of Bula Barangay SAN FRANCISCO
Office of the Punong Barangay
Office No. 0947-184-69681
REPORT OF OFFICIAL TRAVEL
Type of Vehicle
DATE DESTINATION FUEL GREASE PURPOSE OF TRAVEL
CONSUMED
01-27-2024 MSWDO BULA 1.61 PICK UP NUTRIBOND
I HEREBY CERTIFY to the correctness of above information and that the use of the subject Vehicles
ADOLFO R. PENTECOSTES
DRIVER
Prepared by:
LIZA A. ORNIDO
BRGY. TREASURER
Republic of the Philippines
Province of Camarines Sur
Municipality of Bula Barangay PALSONG
Office of the Punong Barangay
Office No. 0947-184-69681
REPORT OF FUEL CONSUMPTION
TYPE OF VEHICLE: BARANGAY PATROL VEHICLE
ITEM & VOLUME LOADED
BALANCE IN TANK O.R.
DATE BEFORE DIESEL GASOLINE OIL 40 OIL 10 OIL 30 B FLUID LUBRICANT AMOUNT
PURCHASED(L) NUMBER
SGB 820
01-11-2024 7.633 6352 500.00
01-17-2024 9.47 2802 500.00
TOTAL 7.633 1,000.00
REVIEWED AND APPROVED BY: APPROVED BY:
MARICEL O. BARBERO LIZA A. ORNIDO
BRGY. TREASURER PUNONG BARANGAY
Republic of the Philippines
Province of Camarines Sur
Municipality of Bula Barangay SAN FRANCISCO
Office of the Punong Barangay
Office No. 0947-184-69681
REPORT OF FUEL CONSUMPTION
TYPE OF VEHICLE: BARANGAY PATROL VEHICLE
ITEM & VOLUME LOADED
BALANCE IN TANK O.R.
DATE BEFORE DIESEL GASOLINE OIL 40 OIL 10 OIL 30 B FLUID LUBRICANT AMOUNT
PURCHASED(L) NUMBER
01-27-2024 1.61 42089 100.00
TOTAL 7.633 100.00
REVIEWED AND APPROVED BY: APPROVED BY:
MARICEL O. BARBERO LIZA A. ORNIDO
BRGY. TREASURER PUNONG BARANGAY
INSPECTION AND ACCEPTANCE REPORT
BARANGAY SAN FRANCISCO Municipality of Bula
Tel. No.________________ Province of Camarines Sur
Supplier: Invoice No. _______ LAR No. RIS No. _______
Date: Date: Date: Date:
ITEM NO. UNIT DESCRIPTION QUANTITY
1 LITERS DIESEL 7.633
2 LITERS DIESEL 9.47
3 LITERS GASOLINE 1.61
INSPECTION
Date inspected: ____________________ Date Received: ___________________
( ) Inspected verified and found OK as to quanlity and ( ) Complete
specifications.
( ) Partial _Please Specify quantity receive
______________________________ MARICEL O. BARBERO
Signature Over Printed Name Signature Over Printed Name
Authorized Inspector Barangay Traesurer
INSPECTION AND ACCEPTANCE REPORT
BARANGAY PALSONG Municipality of Bula
Tel. No.________________ Province of Camarines Sur
Supplier: E. TANTIADO ENTERPRISES, INC. Invoice No. _______ LAR No. RIS No. _______
Date: Date: Date: Date:
ITEM NO. UNIT DESCRIPTION QUANTITY
1 set GANG SW (OMNI) 3
2 SET GANG SW 2
3 SET GANG SW 1
4 PCS ELECTRIC TAPE 3
5 PCS L.E.D. BULB 9W 10
6 PCS L.E.D. BULB 19W 10
7 METERS DROP WIRE #6 160
8 PCS PHILIP SCREW 1
INSPECTION
Date inspected: ____________________ Date Received: ___________________
( ) Inspected verified and found OK as to quanlity and ( ) Complete
specifications.
( ) Partial _Please Specify quantity receive
______________________________ ANNIE E. SERNAL
Signature Over Printed Name Signature Over Printed Name
Authorized Inspector Barangay Traesurer
INSPECTION AND ACCEPTANCE REPORT
BARANGAY PALSONG Municipality of Bula
Tel. No.________________ Province of Camarines Sur
Supplier: Invoice No. _______ LAR No. RIS No. _______
Date: Date: Date: Date:
ITEM NO. UNIT DESCRIPTION QUANTITY
1 METER PDX WIRE #12 4
2 PC AMCO BOX 1
3 PC FLOOR DRAIN 1
4 PC OUTLET 1
5 PC BRASS ROLLER 2
6 PACK EVEREDY 1
7 REAM BOND PAPER 2
8 PC PHILIPPINE FLAG 2
9 PC AIR CLEANER #55 1
10 PC SPRING 1
11 PC POWER SUPPLY 1
INSPECTION
Date inspected: ____________________ Date Received: ___________________
( ) Inspected verified and found OK as to quanlity and ( ) Complete
specifications.
( ) Partial _Please Specify quantity receive
______________________________ ANNIE E. SERNAL
Signature Over Printed Name Signature Over Printed Name
Authorized Inspector Barangay Traesurer
INSPECTION AND ACCEPTANCE REPORT
BARANGAY PALSONG Municipality of Bula
Tel. No.________________ Province of Camarines Sur
Supplier: Invoice No. _______ LAR No. RIS No. _______
Date: Date: Date: Date:
ITEM NO. UNIT DESCRIPTION QUANTITY
1 PC BOLT 1
2 PC BOLT 1
3 PC PADLOCK 1
4 PC SWITCH 3
5 PC ELECTRIC TAPE BIG 1
6 PC RECEPTACLE 5
7 PC 1
8 PC 4
9 PC TIRE 1
10 PC TUBE 1
11 LABOR
12 BOTLE MENIRAL WATER 15
13 PC ESPERMA#5 1
14 PC POSPORO 1
15 PC BAR DETERGENT 1
16 BOTLE SOFTDRINK 12
17 PC DOWEE 8
18 PACK PUDGEBAR 4
19 BOTLE MENIRAL WATER 10
INSPECTION
Date inspected: ____________________ Date Received: ___________________
( ) Inspected verified and found OK as to quanlity and ( ) Complete
specifications.
( ) Partial _Please Specify quantity receive
______________________________ ANNIE E. SERNAL
Signature Over Printed Name Signature Over Printed Name
Authorized Inspector Barangay Traesurer
Republic of the Philippines
Province of Camarines Sur
Municipality of Bula Barangay SAN FRANCISCO
Office of the Punong Barangay
Office No. 09918919889
Control No.
Date
DRIVER 'S TRIP TICKET
A. To be filled by the Administrative Official Authorozing Official Travel:
1. Name of Driver of the vechicle:
2. Government Car to be used
3. Name of authorized passenger:
4. Place or places to be visited/inspected:
5. Purpose:
LIZA A. ORNIDO
Punong Barangay
1. Time of Departure from office/garage am/pm
2. Time of arrival at (per no.4 above) am/pm
3. Time of departure from (per no.4 above) am/pm
4. Approximate Distance travelled (to and from) km
5. Gasoline issued,purchase and consumed:
a. Balance in tank: liters
b. Issued by official from stock: liters
c. Add purchased durinf trip: liters
TOTAL liters
d. Deduct: consummed during work/trip liters
e. Balance in tank at the end of the work/trip: liters
6. Gear oil issued: liters
7. Lub. oil issued: liters
8. Grease issued: liters
9. Speedometer readings, if any:
AT beginnings of trip OUT OF ORDER______________ ml/kms
At end of trip ml/kms
Distance travelled (per No. 5 above) ml/kms
Remarks:
I hereby certify to the correctness of the statement of record of travel.
Passenger Driver/Operator
