CANVASS FORM No. LSD2-2019-073

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Republic of the PhilippinesSOCIAL SECURITY SYSTEM

OFFICE OF THE VICE PRESIDENTLUZON SOUIH 2 DIV|S|ON

SSS Bldg., National Highway, Kumint:;g llaya, Batangas CitySEALED CAlVL:ISS

l

September 2, 2019

Sir / ftiladam:

Please furnish us with your quotation on or before __!cptq!nbetL2q!L for the following items:

The offeror binds hinself to this quolalion's fERMS & COND/I/ONS

Approved Budgeti Php 112,500.00 ;APP #130Detivery Termsr Thirty (30) Calendar Davs from receipt of approved Job Order / Purchase Order.Payment Terms: Suoolier shall be paid in accordance with Government Terms.Price validity i Three (3) monthsArea of Detivery: SSS Boac Branch. 10 De Oktubre St.. Brgv. Malusak. Boac. MarinduqueMode of Evaluation: oer lotTERr!1s AND coNDlTloNS: Kindlv see (Paoe 2 of 2) at the back hereof

This is to cert fy that a ldata / quotation indicated above are valid.

OwnerCompaf y Representative( Sign over Prinled Name)

Please Indicate vout Business Name'

Acldress ancl TeleDhone Numbet and Date Receivecl.

Your Business SSS No.( ln case of Sell-Enployecl, please indicate you. SSS nunbet)

PhilGeps Registration No.

T IN No.

Date Received :

Very Truly Yours (L/tREtN Eb0DtcHo trj

LocalBAC SecretariatSig natu re over p dnted name

Canvassed by:

(Euslness Name)

Signature 0!6r printed name

(Business Address )

No. Quantity PARTICULARS LJnit Cost Total Cost

1 45 Sacks ly and Del very of 45 Sacks of Commercial Rice atBoac Branch

.,.

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Wafianty: _ on i(warchty petud trcn the de

)arts _ on services

itiver/ - ro be lillecl out by the biclder)

(TeLephone No )

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