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: 11/14/2016
Contractor or Vendor Name & Address:
PYBAR
[address]

Attention: Backcharge Invoice No.:

Item Cost Code Description Unit Unit Cost Total Cost Php
SEALANT AUTO SIKAFLEX 221 BLK 6 15.22 91.32
GUN; CAULK; DISPENSER; MANUAL; 1 35.88 35.88
SLING SOFT 3T X 2MTR YELLOW 3 19.33 57.99

185.19

OGPI REPRESENTATIVE:

Roda Mae Genolos

Name Signature Date (mm/dd/yy)

ACCEPTED BY:

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

**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.

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

 11/14/2016

Total Cost Php

91.32
35.88
57.99

185.19

Date (mm/dd/yy)

Date (mm/dd/yy)

cted from the Contractors next Progress Claim in accordance with

acts, otherwise in accordance with the relevant clause of the
contract/purchase order.

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