Form – PUR – 05

PHOENIX MEDICAL SYSTEMS (P) LTD

Issue: 06
Issue Date: 28/12/2019
NEW VENDOR EVALUATION FORM
Page 1 of 3

New Vendor Selection

Supplier Name: ___________________________________________ Date: _____________________

Address(HO) : Address(Factory) :

Contact Person Contact Person

Designation Designation

Phone no Phone no

E-mail E-mail

Website Website

Nature of Business : Material supply Job Work Others

Type of Organization Private Public Others
Industry size : Small Medium Large
Annual Turn Over
Year Established
OE manufacturer : Yes No
Authorised Dealer/Stockiest/Service provider : Yes No
ROHS compliance Yes No
ISO Certified company Yes No
ISO 9001/13485/16949/AS9100C If yes enclose certificate copy

Details of Materials Available / Job Work: List of Major Customers:

Details of Raw Material Source: List of Processes :

 Form – PUR – 05
PHOENIX MEDICAL SYSTEMS (P) LTD
Issue: 06
Issue Date: 28/12/2019
NEW VENDOR EVALUATION FORM
Page 2 of 3

Details of Machineries/Tools: Details of Inspection / Testing Equipment :

Details of Manpower Material Handling and Packing provisions

(Education/Experience/Skilled/Unskilled):

PAN NO : Bank Account Details

Bank Name

Bank Branch
GST NO :
Account Type

Account NO
TAN NO :
IFSC Code

Enclose (If Applicable):

Organisation Chart, Process details, QMS Certificate, Cancelled Cheque leaf, others

Note: All the above details must be filled by Vendor before approval. Technical approval must be obtained
from Phoenix before placing the first order for evaluation.

Vendor Seal and signature

Onsite Evaluation ( Is Required) Yes No

Phoenix Technical Approval By_____________________________ (Signature / Date)

 Form – PUR – 05
PHOENIX MEDICAL SYSTEMS (P) LTD
Issue: 06
Issue Date: 28/12/2019
NEW VENDOR EVALUATION FORM
Page 3 of 3

New Vendor Evaluation

Purchase Orders Details

Tr =
# Period Raised Completed (Qr) (DQr) (DSr) Sign
Qr+DQr+DSr/3
on on

1 Supply – I

2 Supply – II

3 Supply – III

OVERALL

Vendor rating formula:

Quality rating (Qr) = (Accepted Qty / Received Qty) x 100

Quantity rating (DQr) = (Received Qty / Scheduled Qty) x 100
Delivery Schedule rating (DSr) = 100%, if delivered on or before scheduled date
= 75%, if delivered between 1 - 5 days after scheduled date
= 50%, if delivered between 6 - 10 days after scheduled date
= 25%, if delivered between 11 - 13 days after scheduled date
= No rating to be given after 14 days of scheduled date

Quality rating, Quantity rating, Delivery Schedule rating for each individual PO is maintained in excel sheet as
soft copy. Total rating (Tr) is calculated using the above mentioned formula.

Evaluated by: ________________________ Approved by: ______________________

Date: ________________________ Date: ______________________

Note: After final approval, the above vendor should be included in “Approved Vendor List” by Purchase
executive.

Form Approval
Approved By:
Issued By: