138 Maginhawa St.

, Teacher's Village
Quezon City, Philippines

RBGM SUPPLIER LIST (Local)

Classification
Type of
Suppliers Name (APPROVED, CONDITIONAL, Approved Date PRODUCT / SERVICES Address Contact Person Contact No.
Supplier
DISAPPROVED)

Advance Tooling Enterprises Approved Local 22-Apr-22 Medical Accessories & Repair 1654 Soler St. Cor Sales St. Sta. Cruz Manila Mr. Allan Matic +639338260128
New Asiamed Healthcare Inc. Approved Local 10-Oct-22 Medical Suplies 1813 Sobriedad St. Zone 044 Brgy. 442 Sampaloc Manila Ms. Jobelle Derla +639162464333
Metphil Medical Company Approved Local 23-Sep-22 Calibration 3rd Floor Insular Bldg., Abanao Extension, Baguio City Ms. Eraiza Bianca Juanatas +639338173236
JRK Medical Enterprises and Services Approved Local 02-May-22 Repair of Equipment Lot 20 Blk 6 Sitio Casili Consolacion Cebu Engr. Ronald Yara +639171461427
MCCD Enterprises Approved Local 06-May-22 Medical Accessories 245 Teachers Bliss Brgy 201 Kalayaan Village Pasay City Engr. Rommel G. Briones +639950637230
Poweredge Solutions Phils. Inc. Approved Local 25-May-22 Medical Accessories 285-A Haig St., Brgy. Daang Bakal Mandaluyong City 1550 Ms. Lovely Quenano +63 917 145 5683 / +63 998 960 1903
120 Tolentino St. Brgy. Del Monte SFDM Quezon City
Regenaire Industrial Supplies Approved Local 20-Apr-22 Medical Accessories Philippines 1105
Ms. Cristine Caravana +639338231504

Wite Lite Philippines Corporation Approved Local 21-Apr-22 Medical Accessories 1252 Syson St., Brgy. 671, Zone 73, District V, Paco Manila Mr. Ferdinand Estrada +639171755265
NBTCS Consulting and Training Consultant

RBGM-PUR-F-1001 Rev.00 06-17-22

 138 Maginhawa St., Teacher's Village
Quezon City, Philippines

RBGM SUPPLIER LIST International (Principal)

Classification
(APPROVED,
Suppliers Name Type of Supplier PRODUCT / SERVICES Address Contact Person Contact No.
CONDITIONAL,
DISAPPROVED)

Premier Park, 33, Road One Winsford Industrial Estate

Advance Medical Solutions Approved International Medical Accessories Winsford, Cheshire CW7 3RT United Kingdom
Ms. Helen Howarth +44 (0) 1606 545593 (Direct line)

No. 2, Lane 106, Wu-Kong 3rd Rd,

Besmed Health Business Corp. Approved International Medical Suplies Wu-ku District, New Taipei City, Taiwan 24889
Mandy Liu 886-2-2290-3959 (ext. 326)

Medical Equipment, Instruments and 20 Bendemeer Road, #06-01/02 BS Bendeemer Centre,

Gentinge South East Asia Pte Ltd Approved International Supplies Singapore 339914
Teodor Johansson (65)62961992, (65) 62961937

Integra Lifesciences Approved International Medical Instruments and Supplies 1100 Campus Rd, Princeton, NJ 08540 Patricia Trani 609-936-2320
Medical Equipment, Instruments and 2-12-18 Kawaguchi, kawaguchi-shi, Saitama, 332-0015
Metran Co. Ltd Approved International Supplies Japan
Mr. Katsuragi Erick 81(048)242-0333

Medical Equipment, Instruments and

Philips Respironics Inc. Approved International Supplies
174 Tech Center Drive, Suite 100 Mount Pleasant PA 15666 Mr. Rodel Manansala Francisco +63 9173192583

Medical Equipment, Instruments and No. 10 Jalan Ara SD 7/3B,

Schiller Asia Pacific Approved International Supplies
Bandar Sri Damansara, Ms. Yuki Tan +603 6272 3033
52200 Kuala Lumpur, Malaysia

Smith And Nephew Pte. Ltd. Approved International Medical Instriment and Supplies 101 ALPS AVENUE #03-01 SINGAPORE SG 498793 Mr. Oh, Guat Ngoh +65 66725416

Medical Equipment, Instruments and

Zoll Medical Singapore Pte Ltd Approved International Supplies
12 Kallang Avenue #03-24 Aperia Singapore 339511 Ms. Grace Perez +63 917 554 0582

Penthouse Unit A, Clipp Center, 11th Avenue cor. 39th

Carl Zeiss Philippines Pte. Ltd. Approved Local Medical Equipment and Supplies Street Bonifacio Global City, Fort Bonifacio 1634, Taguig Ms. Mylene Brillantes +639176306026
City
Medical Equipment, Instruments and 1901 Picadily Star Bldg. 4th Ave. Cor 27th St. Bonifacio
Karl Storz Endoscopy Philippines, Inc. Approved Local Supplies Global City Taguig City Philippines 1636
Ms. Diana Kristine Carpio +639175735996

Medical Equipment, Instruments and 29th Floor One World Place Ms. Evangelyne Guevarra/Ms.
Medtronic Philippines Inc. Approved Local Supplies 32nd Street Bonifacio Global City, Taguig City 1634 Analiza Sison
+639266905115/+639399105668

RBGM-PUR-F-1002 Rev.00 06-17-22

 SUPPLIER'S EVALUATION FORM

Date: _______________

NAME OF SUPPLIER:
PRODUCTS/SERVICES SUPPLIED:
For the Period Covering:

Please score on a Scale of 1-4 (1 = Needs Improvement, 4 = Excellent)

NOTE: Total rating below 80% shall be subject to Nonconformity and Corrective Action Report.

VERY NEEDS
EXCELLENT GOOD
CRITERIA SCORE SATISFACTORY IMPROVEMENT
4 3 2 1
21% and above of
Product/Service Quality 4 No rejection/No return 1-10% of rejection 11-20% of rejection
rejection
Less than proposed Same of the proposed 5% higher than 10% higher than
Product Prices 3 price price proposed price proposed price

Delivery / Pick Up Time 4 No Delay <1 day delay 2-3 days delay >3 days delay

Support (Response Time) 3 Within office hours Within a day Within 2 days Within 3 days

COD/CHOD/Advance
Payment Terms 2 30 Days/PDC 30 days 15 Days/PDC 15 days 7 Days/PDC 7 days
Payment

Maintenance Response Time (For Equipment) 2 Within office hours Within a day Within 2 days Within 3 days

Total Score: 21

TOTAL RATING [(score/24)x100]: 75%

NOTE: A copy of this form will be sent to supplier via email.

RECOMMENDATION:

Evaluated By: ____________________________________ Evaluated By: ____________________________________

Signature Over Printed Name Signature Over Printed Name
Purchasing Department Biomed Department

Evaluated By: ____________________________________ Evaluated By: ____________________________________

Signature Over Printed Name Signature Over Printed Name
Warehouse Department Finance Department

Evaluated By: ____________________________________ Approved By: ____________________________________

Signature Over Printed Name Signature Over Printed Name
Sales/Marketing Management

Conforme by:

___________________
Supplier Representative

RBGM-PUR-F-1004 Rev.00 06-17-22

 SUPPLIER'S ACCREDITATION FORM
Page 2 of 2

Documents Submitted Not Submitted Not Applicable

Quality and Safety Standard Certificated, i.e. ISO 9001, etc.

SUPPLIERS QUESTIONNAIRE
1. Details of your organization's scope of activity/products/services.
2. Number of months/years in business
3. How many employees does your company have?
4. Does the company belong to any group of companies? Yes No
If yes, please state the name of the company/organization.
5. How many offices do you have? Where are they located?
6. Is there a formal quality department in your company? Yes No
7. What is your standard delivery lead time?
8. Do you keep stocks for your customer? For how many months?
9. How flexible are you in case of PO cancellation or revision?
10. What are your conditions in giving credit terms to your customers?
TO BE FILLED-UP BY SUPPLIER

I certify that the above information are true, complete and correct to the best of my knowledge. I understand that any misrepresentation or material omission
made herein or in any of the docement/s requested by RBGM Nedical Express Sales, Inc. can be constructed as perjury.

Authorized Supplier Representative:

Printed Name, Designation __________________________________________

Signature, Date __________________________________________

TO BE FILLED-UP BY RBGM MEDICAL EXPRESS SALES ONLY

Result of other assessments conducted:

Recommendation:

_________________________ _________________________ _________________________

Recommendation by/Date: Noted by/Date: Approved by/Date:

SAP VENDOR CODE: _________________________

RBGM-PUR-F-1003 Rev.00 06-17-22

 138 Maginhawa St., Teacher's Village
Quezon City, Philippines

ABSTRACT OF CANVASS FORM

PURPOSE: ________________________________________ DATE:

NAME OF SUPPLIER NAME OF SUPPLIER

QTY UNIT ITEM DESCRIPTION #1 UNIT PRICE TOTAL PRICE ITEM DESCRIPTION #2 UNIT PRICE TOTAL PRICE ITEM DESCRIPTION NAME OF SUPPLIER #3 UNIT PRICE TOTAL PRICE Remarks

Note: RBGM required supplier to give atleast 1 piece sample in each item needed.

SUPPLIER 1: SUPPLIER 2: SUPPLIER 1:

ADDRESS: ADDRESS: ADDRESS:
CONTACT #: CONTACT #: CONTACT #:
CONTACT PERSON: CONTACT PERSON: CONTACT PERSON:

CANVASSED BY: REQUESTED BY: ENDORSED FOR APPROVAL BY: APPROVED BY:

Name & Signature/Date Name & Signature/Date Immediate Head Operations Manager/Managing
Director

RBGM-PUR-F-3001 Rev.00 06-17-22

 Non-Conformity and Corrective Action Report Form

NCAR No. Pls return on :

Department: Recipients:
Initiator: Date Issued:

1 .Type of nonconformance (Tick where appropriate) x

Internal Audit Findings Nonconforming Outputs
External Audit Findings Supplier Nonconformance
Customer Complaint Environmental Issues
Legal Nonconformance Accident/ Emergencies
others

2. Problem Description: Describe the problem (what, when, who, where , how many )
What ? How many?
When?
Where?

3. Reaction to the Problem

Correction Containment/Control
Segregation Customer reconsideration
deal with the consequence Customer Information

4. Details of Action Taken

What When Who Verified by

5. Verification of output : ( for nonconforming output only )

Accepted by

6.Root cause analysis : ( Use fishbone diagram , 5 whys analysis)

Why 1? Why 3? Why 5?

Why 2? Why 4?

7.Corrective Action
What When Who

8. Verification of Corrective action Action Verified by

First verification ( After 3 months )
Second verification ( After 6 months )
Third verification ( After 9 months )
Congratulate the team after 9 months of no. occurrence
Update the following documents:
Risk registry updated? Document change updated?
Yes Yes state DCN no.
No explain why No explain why no ?

Approved by :
Date Name and signature

RBGM-TM-F-8001 Rev.00 06-17-22

 138 Maginhawa St., Teacher's Village
Quezon City, Philippines

PURCHASE ORDER

To : PR reference #:
Terms: Purchase Order #:
Quotation Ref.: Date Issued:

Code Qty Description Unit Unit Price Total Price

*** NOTHING FOLLOWS ***

TOTAL AMOUNT 0.00

Order Notes:

Prepared by:
Purchasing Staff

Checked by:
Purchasing Supervisor

Approved by:
Verlaine Cariño
Corporate Services Group Director

Purchase order number must appear on all Invoices, DR's and packages. Delivery receipt and/or invoices must accompany
goods and be endorsed with the Purchase order number.Otherwise, acceptance will be refused. Invoices must be submitted
within ten(10) days if delivery is made against Delivery Receipt only. Payment will be made against Original Invoices.

RBGM-PUR-F-3002 Rev.00 06-17-22

 138 Maginhawa Street, Teacher's Village,
Quezon City, Philippines

BFF Reference No.

Bidding Forecast Form

Hospital Forecast 1 Forecast2 Forecast3 Forecast4
Code Description NOA QTY Month Qty Month Qty Month Qty Month Qty Remarks

Requested by: Approved by:

Date Submitted: Noted by:

RBGM-PUR-F-3003 Rev.00 06-17-22

 138 Maginhawa Street, Teacher's Village,
Quezon City, Philippines

PURCHASE REQUEST FORM

Code Description Qty UOM Hospital / Customer Date Needed Remarks

FASTEST INTUBATION CONTEST ROLL UP 1 RBGM MEDICAL EXPRESS SALES 11/20/2023

NOTE: PREPERRED
SUPPLIER IS AC PRINT

Requested by: ALLYSSA BUENAVENTURA Approved by:

Date Submitted: 11/20/2023 Date Approved:

RBGM-PUR-F-3004 Rev.00 06-17-22

 BUSINESS CASH ADVANCE REQUEST (BCAR)
REQUEST TYPE: Others PAYMENT CASH
* attach necessary documents MODE: CHECK
Payee:
REQUESTED AMOUNT: FOR PICK-UP
Name:
BREAKDOWN OF REQUESTED AMOUNT PER DIVISION: FOR DEPOSIT
SI Bank:
MIS Account No.:
LSS Account Name:
LSM
REGION CODE: MM DATE NEEDED:
LOCATION AREA CODE: MM1
DIVISION AREA CODE: SUP-PUR SUPERVISORY
PROJECT CODE: NOTES:

HOSPITAL/CUSTOMER:

JUSTIFICATION:
* include ROI,
Projects, Details of Expenses,
etc.

ACCOUNTING Date Released:

NOTES: Voucher No.:
Liquidation Date:

REQUESTED BY: NOTED BY: APPROVED BY:

Signature over Printed Name / DATE Signature over Printed Name / DATE Signature over Printed Name / Date

BUSINESS CASH ADVANCE REQUEST (BCAR)

REQUEST TYPE: Revolving Fund PAYMENT CASH
* attach necessary documents MODE: CHECK
Payee:
REQUESTED AMOUNT: - FOR PICK-UP
Name:
BREAKDOWN OF REQUESTED AMOUNT PER DIVISION: FOR DEPOSIT
SI Bank:
MIS Account No.:
LSS Account Name:
LSM
REGION CODE: MM DATE NEEDED:
LOCATION AREA CODE: MM1
DIVISION AREA CODE: SUPERVISORY
PROJECT CODE: NOTES:

HOSPITAL/CUSTOMER:

JUSTIFICATION:
* include ROI,
Projects, Details of Expenses,
etc.

ACCOUNTING Date Released:

NOTES: Voucher No.:
Liquidation Date:

REQUESTED BY: NOTED BY: APPROVED BY:

Signature over Printed Name / DATE Signature over Printed Name / DATE Signature over Printed Name / Date
 Request for Advance Payment Form
138 Maginhawa Street, Teacher's Village East, Q.C.

Tel. No. 426-0268 Fax loc. 107

Supplier:
Payment Terms:
Commodity:

PO No. Invoice No. Invoice Date Invoice Amount Total Amount

€ -
€ -
€ -
€ -

Note:

Prepared by: Checked by: Approved by:

Rona Jeresano VERLAINE G. CARINO

Purchasing Staff Purchasing Supervisor Corporate Services Group Director

RBGM-PUR-F-6002 Rev.00 06-17-22

 Request for Payment Form
138 Maginhawa Street, Teacher's Village East, Q.C.

Tel. No. 426-0268 Fax loc. 107

Supplier:
Payment Terms:
Commodity:

PO No. Invoice No. Invoice Date Invoice Amount Total Amount

€ -
€ -
€ -
€ -

Note:

Prepared by: Checked by: Approved by:

Rona Jeresano VERLAINE G. CARINO

Purchasing Staff Purchasing Supervisor Corporate Services Group Director

RBGM-PUR-F-6001 Rev.00 06-17-22

 SUPPORT EXPENSE REIMBURSEMENT / BCAR LIQUIDATION REPORT
NAME: DATE:
PERIOD COVERED: TYPE:

CAR PLATE No. ✘ BCAR LIQUIDATION

LOCATION AREA DIVISION AREA

DATE LOCATION DIVISION CODE REGION CODE EXPENSE TYPE DETAILS
CODE CODE

Metro Manila SUP MM MM1 Others

LESS EWT:

EMPLOYEE SIGNATURE:
TOTAL EXPENSE AMOUNT: -

TOTAL BCAR AMOUNT: -

Signature over Printed Name / DATE
 WAREHOUSE STOCK TRANSFER REQUEST (WST)
DATE: WST NO.: WST22-0001

FOR PURCHASING ONLY

DESTINATION
SOURCE (WAREHOUSE - (WAREHOUSE - BIN ONE (1) MONTH CURRENT STOCK OPEN ORDER
PRODUCT CODE PRODUCT DESCRIPTION SERIAL/LOT NO. EXPIRY DATE QUANTITY UOM BIN LOCATION) LOCATION) AVERAGE SALES QUANTITY QUANTITY BALANCE
QUANTITY

NOTES:

REQUESTED BY: PULL OUT BY:

APPROVED BY: RECEIVED BY:

RBGM-WHS-F-1001 Rev.00 06-17-22