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Canvass Form

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Republic of the Philippines

Department of Transportation & Communications


MARITIME INDUSTRY AUTHORITY
Regional Office XIII (CARAGA)
Surigao City

CANVASS FORM

Date:_____________
___________________________
___________________________
___________________________
___________________________

Gentlemen/Madams:

Please quote your lowest price/prices to the government for the item/items listed below
and state your detailed specifications.

It is important that this form is properly and accurately accomplished and submitted in a
sealed envelope directly to the Secretary, Canvass Committee not later than ______ days from
today.

Very truly yours,

Signature of Canvassers: ____________________


Printed Name : ____________________________

ITE Articles and their detailed description


M QTY UNIT Price
NO. MARINA’s Specifications Bidder’s Specifications

FOR: The Canvass Committee, MARINA

We are pleased to submit the above quotation/s together with our detailed specifications
on the above indicated item/s for delivery to the Supply Officer, Maritime Industry Authority on
the date to be fixed by that Committee.

Business Name: _________________________ Signature: __________________________


Business Address: _______________________ Printed Name: _______________________
Tel. No.:_______________________________ Position: ___________________________

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