FORM 3

PPP Center
Medium Term Expenditure Program - PDMF
(in thousand Pesos)

Particulars
(1)

Approved Amount
(2)

Projected Disbursement
(3)

Remarks
(4)

2012

2013

2014

2015

2016

Department

PPP 1

Activity 1

Activity 2

Activity n

PPP 2

Activity 1

Activity 2

Activity n

PPP n

Activity 1

Activity 2

Activity n

Department n

PPP 1

Activity 1

Activity 2

Activity n

PPP 2

Activity 1

Activity 2

Activity n

PPP n

Activity 1

Activity 2

Activity n

TOTAL

Prepared by:

_______________________

Financial Analyst V

Certified Correct:

______________________
Director

Approved by:

______________________

Executive Director

PPP Center
Medium Term Expenditure Program - PDMF

Instructions:

1. This form shall be accomplished to determine the projected medium-term requirements of the PDMF based on on-going and projected PPP projects.

2. Column 1 shall contain information on PPP projects and activities of the concerned department(s) to be charged against the PDMF as listed under item

4.2 of National Budget Circular (NBC) No.______________ issued on February _________,2012.

3. Column 2 shall indicate the amount approved by the PDMF Board.

4. Column 3 shall indicate the projected requirements for projects and activities for 2012 to 2016.

5. Assumptions for projected requirements for 2012-2016 shall be indicated in "Remarks" column.