REQUEST FORM

Dr Hamawi

1. 56815 RELYX UNICEM APLICAP 34 pcs 700 sr

2. 3m FIBER POST (56499/56862/56863) 4 Box 1,640 sr

3. FILTEX Z250 RESTORATIVE SYRINGE 1 pc 115 sr

TOTAL 2,445

Dr aseem

1. D-LL-5-N1-CHRO CROWN PRIM MOLA 8 box X 35 sr 280 sr

2. 37200 KETAC CEMENT 1 box 212 sr

3. 41282 SINGLE BOND ORANGE 1 pc 231 sr

4. FILTEX Z250 RESTORATIVE SYRINGE A1 - 115 sr A2 - 115 sr 230 sr

5. 7032A1 FILTEX 7350 XT FLOWABLE 1 pack 166 sr

Total 1,119 sr

Dra Rawaa

1. 56815 RELYX UNICEM APLICAP 33 capsule 700 sr

2. 3m FIBER POST (56499/56862/56863) 4 box 1,640 sr

3. FILTEX Z250 RESTORATIVE SYRINGE A1 - 115 / A2 - 115 230 sr

4. 41282 SINGLE BOND ORANGE 1 pc 231 sr

5. 46959 PROTEMP BLEACH 1 box 388 sr

6. 37200 KETAC CEMENT 1 box 212

7. 56895 RELYX U200 AUTOMIX 1 box 440 sr

8. 7032A1 FILTEX 7350 XT FLOWABLE 1 pack 166 sr

Total 4,007 sr

1
 REQUEST FORM

Dr Eemad

1. 56815 RELYX UNICEM APLICAP 33 capsule 700 sr

2. 3m FIBER POST (56499/56862/56863) 4 box 1,640 sr

3. 41282 SINGLE BOND ORANGE 1 pc 231 sr

4. FILTEX Z250 RESTORATIVE SYRINGE A2 ( 1 pc) 115 sr

5. 7032A1 FILTEX 7350 XT FLOWABLE 1 pc 166 sr

Total 2,852 sr

Total Summary

Dr Hamawi 2,455 sr

Dr Aseem 1,119 sr

Dra Rawaa 4,007 sr

Dr Eemad 2,852 sr

Total 10,433 sr

Total receipt from Nabeel 11,409

Total received in clinic - 10,433

Total remaining 976 sr

Didn’t received

7032A1 FILTEX 7350 XT FLOWABLE 1 pack- 166 sr

46959 PROTEMP BLEACH 1 box - 388 sr

Return Materials

2
 REQUEST FORM
41282 SINGLE BOND ORANGE 284 sr

8714 WO RELYX VENEER CEMENY 138 sr

Didn’t received materials 554 sr

Return Materials 422 sr

Total: 976 sr