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RSMI Blank Form

The document is a report of supplies and materials issued by the Department of Agrarian Reform. It lists various office supplies issued including looseleaf covers, insecticide, air fresheners, batteries, brooms, markers, notebooks, paper clips, cleaning supplies, and various types of paper. The report provides the item descriptions, quantities issued, unit costs, and totals for accounting purposes. It is signed by the supply custodian and accounting staff to certify the information.

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D Delos Sal
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87 views6 pages

RSMI Blank Form

The document is a report of supplies and materials issued by the Department of Agrarian Reform. It lists various office supplies issued including looseleaf covers, insecticide, air fresheners, batteries, brooms, markers, notebooks, paper clips, cleaning supplies, and various types of paper. The report provides the item descriptions, quantities issued, unit costs, and totals for accounting purposes. It is signed by the supply custodian and accounting staff to certify the information.

Uploaded by

D Delos Sal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Appendix 64

REPORT OF SUPPLIES AND MATERIALS ISSUED

Entity Name: DEPARTMENT OF AGRARIAN REFORM Serial No.


Fund Cluster: Date:
To be filled up by the Supply and /or Property Division / Unit To be filled up by the Accounting Div./Unit
Responsibility
RIS No. Center Code Stock No. Item / Description Unit Qty Issued Unit Cost Amount
LOOSELEAF COVER, made of chipboard, For legal -

Recapitulation: Recapitulation:

UACS Object
Unit Cost Total Cost
Stock No. Quantity Code

Supplier: PS-DBM
E-User:
DR #:
SI #:
RIS #:
PO #:
PR #:
Fund : 101

I hereby certify to the correctness of the above information Posted by :

JONIE P. ABANTE
Signature over Printed Name of Supply Signature over Printed Name
of Designated Accounting Date
and / or Property Custodian Staff
DAR - QF - 117 REV 00
Acetate Insecticide, aerosol type, net content: 600ml min

Air Freshener, aerosol, 280ml/150g min Magazine File Box, Large

Alcohol, ethyl, 68%-70%, scented, 500ml (-5ml) Marker, Fluorescent, 3 colors per set

Battery, dry cell, AA, 2 pieces per blister pack Marker, Permanent, bullet type, black

Broom, Soft (Tambo), weight: 200g min tiger grass Marker, Whiteboard, black

Broom, Stick (Tingting) Mophead, made of rayon, weight: 400 grams min

Cartolina, Assorted colors., 20 pieces per pack Mouse, Optical, USB connection type, 1 unit/box

Cleanser, Scouring Powder, 350g min./can Notebook, Stenographer, spiral, 40 leaves

Clearbook, A4 size Notepad, Stick-on, 2x3, 100 sheets per pad

Clearbook, Legal Notepad, Stick-on, 3x3, 100 sheets per pad

Clip, Backfold, 25MM, 12 pieces per box Notepad, Stick-on, 3x4, 100 sheets per pad

Correction Tape, 1 piece in individual plastic Pad Paper, Ruled

Cutter Blade, 10 pieces per tube Paper Clip, 32MM, 100 pieces per box or 52 grams (min)

Cutter Knife Paper Clip, 48MM, 100 pieces per box or 120 grams (min)

Data File Box, made of chipboard, with closed ends Paper, Multicopy, 80gsm, size: 210mm x 297mm (A4)

Data Folder, made of chipboard, taglia lock Paper, Multicopy, 80gsm, size: 216mm x 330mm (Legal)

Dating and Stamping Machine Paper, Parchment, 100 sheets per box

Detergent Powder, all purpose, 1kg per plastic pouch Paper, Thermal, 216MM x 30MM

Disinfectant Spray, aerosol type, 400-550 grams Pencil Sharpener, 1 piece in individual plastic case

Dust Pan, Non-Rigid Plastic Pencil, Lead with eraser, 12 dozens per box

Electric Fan, Stand Type Printer, Laser, Monochrome

Electric Fan, Wall Type Puncher, paper, heavy duty, with 2-hole guide, 1pc/box

Envelope, Documentary, for A4 size document, 500pc/box Record Book, 300 pages, size:214mm x 278mm min

Envelope, Documentary, for legal size document, 500pc/box Record Book, 500 pages, size:214mm x 278mm min

Envelope, Expanding Plastic Ring Binder, Ploastic, 32MM, 10 pieces per bundle

Envelope, Expanding, Kraftboard, legal size doc, 100pcs/box Rubber Band, 70mm min lay flat length (#18)

Eraser. Felt, for Balckboard or Whiteboard Scissors. Symmetrical, blade length: 65mm, 1 piece/plastic

External Hard Drive, 1TB, 2.5"HDD, USB 3.0, 1 unit/box Signpen, Black, liquid/ gel ink, 0.5mm needle tip

Facsimile Machine Signpen, Blue, liquid/ gel ink, 0.5mm needle tip

Fastener, Metal, 70mm between prongs, 50 sets per box Stamp Pad Ink, purple or violet, 50ml (min)

File Tab Divider, A4, 5 colors per set Stamp Pad, Felt, bed dimension: 60mm x 100mm

File Tab Divider, Legal, 5 colors per set Staple Wire, Heavy Duty, 23/13

Flash Drive, 16GB capacity, 1 piece in individiual blister pack Staple Wire, Standard

Folder, Fancy, A4, 50 pieces per bundle Stapler, Standard Type, 200 staples min, 1 piece/box

Folder, Fancy, Legal, 50 pieces per bundle Tape Dispenser, Handheld

Folder, L-Type, A4 size, 50 pieces per pack Tape Dispenser, Table Top

Folder, L-Type, Legal size, 50 pieces per pack Tape Dispenser, Table Top

Folder, Pressboard, size: 240mm x 370mm (-5mm) 100pc/box Tape, Masking, width: 24mm (+1mm)

Folder, Tagboard, for A4 size docs, 100 pieces per pack Tape, Masking, width: 48mm (+1mm)

Furniture Cleaner, aerosol, 300ml min./can Tape, Packaging, width: 48mm (+1mm)

Glue, all purpose, gross weight: 200 grams min Tape, Transparent, width: 24mm (+1mm)

Index Tab, 5 sets per box Tape, Transparent, width: 48mm (+1mm)

Ink Cart, Brother LC67HYBK, Black Toilet Tissue Paper, 2-plys sheets, 150 pulls, 12rls/pk

Ink Cart, Brother LC67HYC, Cyan Toner Cart, Brother TN-3320, Black

Ink Cart, Brother LC67HYM, Magenta Toner Cart, HP CB435A, Black

Ink Cart, Brother LC67HYY, Yellow Toner Cart, HP CE285A (HP85A), Black

Ink Cart, Canon CL-811, Colored Toner Cart, HP Q2612A, Black

Ink Cart, Canon PG-810, Black Toner Cart, Samsung MLT-D203L, Black

Ink Cart, HP C9351AA, (HP21), Black Toner Cart, HP CF271A (HP17A), Black

Ink Cart, HP C9352AA, (HP22), Tri-color Twine, Plastic

Ink Cart, HP CC640WA, (HP60), Black Wastebasket, Non-Rigid Plastic

Ink Cart, HP CC643WA, (HP60), Tri-color Wrapping Paper, 50 sheets per pack

Ink Cart, HP CD972AA, (HP 920XL), Cyan Ink Cart, HP F6V27AA (HP680), Black

Ink Cart, HP CD973AA, (HP 920XL), Magenta Ink Cart, HP F6V26AA (HP680), Tri-Color

Ink Cart, HP CD974AA, (HP 920XL), Yellow Envelope, Mailing, White, 80gsm

Ink Cart, HP CD975AA, (HP 920XL), Black


Ink Cart, HP CH561WA, (HP61), Black
Ink Cart, HP CH562WA, (HP61), Tricolor

Ink Cart, HP CN692AA, (HP704), Black

Ink Cart, HP CN693AA, (HP704), Tricolor

Ink Cart, HP CZ107AA, (HP678), Black

Ink Cart, HP CZ108AA, (HP678), Tricolor


Appendix 63

REQUISITION AND ISSUE SLIP

Entity Name: DEPARTMENT OF AGRARIAN REFORM Fund Cluster: ____________


Division: Responsibility Center Code:
Office: RIS No.:
Requisition Stock Available? Issuance
Stock No. Unit Item / Description Quantity Yes No Quantity Remarks
Bundle LOOSELEAF COVER, made of chipboard, For l 1 Issued
pad Notepad, Stick-on, 2x3, 100 sheets per pad 30
pad Notepad, Stick-on, 3x3, 100 sheets per pad 30
pad Notepad, Stick-on, 3x4, 100 sheets per pad 30
piece Notebook, Stenographer, spiral, 40 leaves 25
ream Paper, Multicopy, 80gsm, size: 210mm x 297m 30
ream Paper, Multicopy, 80gsm, size: 216mm x 330m 30
ream Paper, Multi-Purpose, (COPY)A4 70gsm 5
ream Paper, Multi-purpose (copy) Legal 70 gsm 5
pad Pad Paper, Ruled 5
roll Paper, Thermal, 216MM x 30MM 10
book Record Book, 300 pages, size:214mm x 278m 10
pack Toilet Tissue Paper, 2-plys sheets, 150 pulls, 1 17
jar Glue, all purpose, gross weight: 200 grams min 1
box Staple Wire, Standard 25
roll Tape, Masking, width: 24mm (+1mm) 5
roll Tape, Masking, width: 48mm (+1mm) 5
roll Tape, Packaging, width: 48mm (+1mm) 5
roll Tape, Transparent, width: 24mm (+1mm) 25
roll Tape, Transparent, width: 48mm (+1mm) 25
piece RULER, Plastic, 450 mm(18") , width:38mm ru 10
pc External Hard Drive, 1TB, 2.5"HDD, USB 3.0, 1 2
pc Flash Drive, 16GB capacity, 1 piece in individiua 10
box Clip, Backfold,All metal , 19MM, (-1mm) 15
box Clip, Backfold,All metal , 25MM, (-1mm) 15
box Clip, Backfold,All metal , 32MM, (-1mm) 15
box Clip, Backfold,All metal , 50MM, (-1mm) 15
pc Correction Tape, 1 piece in individual plastic 15
pc Data File Box, made of chipboard, with closed 15
pc Data Folder, made of chipboard, taglia lock 5
box Fastener, Metal, 70mm between prongs, 50 set 2
set File Tab Divider, A4, 5 colors per set 3
set File Tab Divider, Legal, 5 colors per set 3
pack Folder, L-Type, A4 size, 50 pieces per pack 5
pack Folder, L-Type, Legal size, 50 pieces per pack 5
box Folder, Pressboard, size: 240mm x 370mm (- 5
pc Marker, Whiteboard, black 10
pc Marker, Whiteboard, blue 10
pc Marker, Whiteboard, red 10
pc Marker, Permanent, bullet type, blue 10
pc Signpen, Black, liquid/ gel ink, 0.5mm needle ti 30
pc Signpen, Blue, liquid/ gel ink, 0.5mm needle tip 30
pc Signpen, Red, liquid/ gel ink, 0.5mm needle tip 30
pc Marker, Permanent, bullet type, black 10
pc Marker, Permanent, bullet type, red 20
box Paper Clip, 32MM, 100 pieces per box or 52 gr 10
box Paper Clip, 48MM, 100 pieces per box or 120 g 10
pc Pencil Sharpener, 1 piece in individual plastic 2
pc Scissors. Symmetrical, blade length: 65mm, 1 p 2
pc Staple Wire, Heavy Duty, 23/13 1
pc staple remover , plier type 5
pc Tape Dispenser, Table Top 24mm width tape 2
pc Calculator, Compact, 12 digits 3
pc Clearbook, A4 size 30
PC Clearbook, Legal 30
xxxxNothing Follows xxxx

P.O. NO.:
SUPPLIER:
DR / SI NO.:

Purpose: For the official use of DARCO-

Requested by: Approved by: Issued by: Received by:


Signature
Printed Name GLORIA M. JULIANO
Designation Chief, GSD
Date:
DAR - QF-114 REV 00
DAR - QF-114 REV 00
F-114 REV 00

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