CONTRACTOR/ VENDOR BACKCHARGE INVOICE

CONTRACT NUMBER OR PURCHASE ORDER NUMBER D0202

CONTRACTOR OR VENDOR NAME AND ADDRESS DATE:

Holcim Philippines
7th Floor, two World Square, McKinley Hill
Fort Bonifacio Taguig City 1634

ATTENTION: (Name)

BACKCHARGE INVOICE NUMBER BC0005

Item No. Cost Code Description Unit Unit Cost Total Cost Php

Total 0 0 0

OGPI REPRESENTATIVE:

Name Signature Date(mm/dd/yy)

ACCEPTED BY:

Contractor/Vendor Signature Date(mm/dd/yy)

* Template: OGPI-FI-CBI-0109
Rev0 (08/02/14)
**Please note Backcharges will be deducted from the Contractors next Progress Claim in accordance with Clause 4.2.10.1 of Volume 3
contracts, otherwise in accordance with the relevant clause of the contract/purchase order.

* Template: OGPI-FI-CBI-0109
Rev0 (08/02/14)
 Contractor-Vendor
.
Backcharge Invoice
Contract or PO No.: Date:
Contractor or Vendor Name & Address:
RAMA
[address]

Attention: Backcharge Invoice No.:

Item Cost Code Description Unit Unit Cost

12546 RAINCOAT HI VIS 2 PIECE SET SIZE: MEDIUM 4 48.45

OGPI REPRESENTATIVE:

Jerryme Layderos
Name Signature

ACCEPTED BY:

Contractor/Vendor Signature

**Please note Backcharges will be deducted from the Contractors next Progress Claim in accordance with Clause 4.
Volume 3 contracts, otherwise in accordance with the relevant clause of the contract/purchase order.

OceanaGold PDG-Execution PDG-363-FOR-006-1 Page 3 of 4

 11/27/2016

Total Cost Php

193.8

Date (mm/dd/yy)

Date (mm/dd/yy)

e Contractors next Progress Claim in accordance with Clause 4.2.10.1 of

ance with the relevant clause of the contract/purchase order.

OceanaGold PDG-Execution PDG-363-FOR-006-1 Page 4 of 4