Copy of: SMART

DATE: February 25, 2020

BATCH NUMBER:
REPLENISHMENT /RETURN FORM
REPLENISHMENT RETURN
ORIGIN SPM PLDT TAMBO ORIGIN TELEDOTCOM STA CRUZ, MARINDUQUE
Address PLDT TAMBO BLDG.226 QUIRINO AVE. TAMBO Address Burgos St, Brgy. Bagong Silang, Sta Cruz,Marinduque
Contact Person MAT MICHAEL B. BURCE Contact Person LAWRENCE M. ROLLUQUI
Contact Number 09611200009 Contact Number 09212588477
DESTINATION TELEDOTCOM STA CRUZ, MARINDUQUE DESTINATION SPM PLDT TAMBO
Address Burgos St, Brgy. Bagong Silang, Sta Cruz,Marinduque Address PLDT TAMBO BLDG. 226 QUIRINO AVE. TAMBO, PARAÑAQUE CITY
Contact Person LAWRENCE M. ROLLUQUI Contact Person MAT MICHAEL B. BURCE

Contact Number 09212588477 Contact Number 09611200009 iHelp Ticket Number

BILLED TO: PLDT BILLED TO: PLDT
Mode of Transaction Airway Bill Number Mode of Transaction Airway Bill Number
NO ITEM CODE DESCRIPTION QTY SO TYPE REMARKS ITEM CODE DESCRIPTION QTY SO TYPE REMARKS
1 LTE_OutDoor 2 Technical Support LTE_OutDoor 2 Technical Support DEFECTIVE
2 LTE_ROUTER 2 Technical Support LTE_ROUTER 0 Technical Support DEFECTIVE
3 LTE_ROUTER-POE 2 Technical Support LTE_ROUTER-POE 0 Technical Support DEFECTIVE
4 FTP 0 Technical Support LTE_OutDoor 0 Pullout IVPD
5 DSS 0 Technical Support LTE_ROUTER 0 Pullout IVPD
6 UTP 0 Technical Support LTE_ROUTER-POE 0 Pullout IVPD
7 FTP 0 Technical Support DEFECTIVE
8 FTP Pullout 0 Pullout IVPD
9 DSS Pullout 0 Pullout IVPD
DSS 0 Technical Support DEFECTIVE
UTP 0 Technical Support DEFECTIVE

PREPARED BY APPROVED BY PREPARED BY APPROVED BY

MAT MICHAEL B. BURCE JAN JONARD BADILLO

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

RECEIVED BY (courier/representative/requisitioner) RECEIVED BY (courier/representative/requisitioner)

MAT MICHAEL B. BURCE

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
 EQUIPMENT DETAILS
NOTE TO BE FIILED OUT BY CONTRACTOR

Desc.
So# SoType Contractor Brand (Antenna/Rout SERIAL NUMBER WAN MAC
er)

TELEDOTCOM.MARI
TSCPE1 LTE GREENPOCKET OUTDOOR ANTENNA
NDUQUE
3886771

TELEDOTCOM.MARI
3887339 TSCPE1 LTE GREENPOCKET OUTDOOR ANTENNA
NDUQUE
TAILS
NTRACTOR

IMEI/I_IMEI SRN ACCOUNTNAME CONTRACTOR REMARKS

Connection restored after replacing defective

PLDT Ultera LTE unit (Antenna) no signal
353152081346126 9211334605 ROSAVILLA LACEDA PAR

Connection restored after replacing defective

353152081218689 9211314426 MA GRACE M. ROLLUQUI
PLDT Ultera LTE unit (Antenna) no signal
 EQUIPMENT DETAILS - Consumables
NOTE TO BE FIILED OUT BY CONTRACTOR
CONTRACT
BRAND SERIAL# SO SRN ACCOUNTNAME OR
REMARKS
sumables
ACTOR
DATE
S.O TYPE TESTING REMARKS
TESTED