Best Diagnostic Corporation Page : 1 of 2

P1 - 07 12TH Corner Manlunas Street, Villamor Airbase, Pasay City Philippines

Tel. No.: 920-1023 / 927-6783 / 928-0861

DELIVERIES AND RECEIVING REPORT

SUPPLIER : AVISHAI STAR ENTERPRISES R.R No. : 70

Invoice No. : 1440 P.O No. : 114
Date : 10/22/2019 P.R No. :

QUANTITY UNIT DESCRIPTION UNIT PRICE AMOUNT

1.00 BOX FILM X RAY 14 X17 4,000.0000 4,000.00

1.00 BOX FILM X RAY 11 X14 2,700.0000 2,700.00
1.00 BOX MANUAL DEVELOPER POWDER 845.0000 845.00
1.00 BOX MANUAL FIXER POWDER 845.0000 845.00

TOTAL DISCOUNT >>> 0.00 TOTAL VAT >>> 0.00 NET AMOUNT >>> 8,390.00

Account Code Account Description Debit Credit

100900 - WH0018 - IC0021 INVENTORIES - PURCHASING - IMAGING SUPPLIES 8,390.00 0.00

200000 - 000000 - 000000 A/P CLEARING ACCOUNT 0.00 8,390.00
8,390.00 8,390.00

SUPPLIERS PERFORMANCE EVALUATION DELIVERY PERFORMANCE

I. SUPPLIERS CLASSIFICATION: III. QUANTITY DELIVERY: YES
Primary Non-Primary NO
Authorized Supplier Un-Authorized Supplier 1. Does achieve 100% delivery of all ordered supplies?
II. COMMITMENT TO PRODUCT QUALITY: YES NO
N/A IV. TIMELINESS OF DELIVERY:
1. Does supplier provides reagent products w/ at least 18 month shelf life? 1. Does all purchased order delivered within 3 days?

2. Does supplier replace products six months prior to expiration? V. COST PERFORMANCE:
1. Competitiveness,fair pricing,and provides
3. Delivers laboratory reagents w/in specified temperature? cost reduction?
2. Using a cost-based system,does a buyer able
*If no please specify the temperature______C * Monitored by: ___________________ to quantify additional costs if a supplier fails to
perform as expected?
4. Does the laboratory reagent delivered with thermometer?

5. Replacing substandard products w/c was damaged upon delivery?

Remarks :

Received By: Noted By : Approved By:

CARILLO, HAROLD ROSEMARIE S. BALISI, M.D.

Run Date : 10/22/2019 5:52:28 PM

Best Diagnostic Corporation Page : 2 of 2
P1 - 07 12TH Corner Manlunas Street, Villamor Airbase, Pasay City Philippines
Tel. No.: 920-1023 / 927-6783 / 928-0861

DELIVERIES AND RECEIVING REPORT

SUPPLIER : AVISHAI STAR ENTERPRISES R.R No. : 70

Invoice No. : 1440 P.O No. : 114
Date : 10/22/2019 P.R No. :

Received By: Noted By : Approved By:

CARILLO, HAROLD ROSEMARIE S. BALISI, M.D.

Run Date : 10/22/2019 5:52:28 PM