Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form No.: MCC-CONC-004
CONSIGNMENT OFFER Revision No.: Ø
Effectivity Date: August 13, 2018

Name of Consignor: __
Address:
Contact No.:

Dear Sir/Madam:
In connection with the Invitation to Consign No.: 2018-01 scheduled on August 23, 2018 for the Consignment of Various Drugs and Medicines, I/We in conformity with the specification/s
hereunder intend to consign the following:

Item Description (Complete

Unit Price
No. ITEMS (Generic Name for drugs and Specifications) Batch No./ Manufacturing Sub-Packing
Unit of Issue Expiration Date (amount in figures and
Medicine) Strength/ Preparation (if Lot No. Date Unit
words)
applicable)

Total Cost:

Name of Company/Consignor:

Name of Authorized Representative

Signature over Printed Name
Date:
 Republic of the Philippines
Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form No.: MCC-CONC-004
CONSIGNMENT OFFER Revision No.: Ø
Effectivity Date: August 13, 2018

Name of Consignor: __
Address:
Contact No.:

Dear Sir/Madam:
In connection with the Invitation to Consign No.: 01 s. 2019 scheduled on February 21, 2019 for the Consignment of ORTHOPEDIC IMPLANTS, I/We in conformity with the specification/s
hereunder intend to consign the following:

Item
Unit Price
No. / Description (Complete Country of Sub-Packing
ITEMS Unit of Issue Brand Manufacturer (amount in figures and
Lot Specifications) Origin Unit
words)
No.

Total Cost:

Name of Company/Consignor:

Name of Authorized Representative

 Signature over Printed Name
Date:

Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form No.: MCC-CONC-004
CONSIGNMENT OFFER Revision No.: Ø
Effectivity Date: August 13, 2018

Name of Consignor: __
Address:
Contact No.:

Dear Sir/Madam:
In connection with the Invitation to Consign No.: 02 s. 2019 scheduled on February 21, 2019 for the Consignment of ENT IMPLANTS, I/We in conformity with the specification/s hereunder
intend to consign the following:

Item
Unit Price
No. / Description (Complete Country of Sub-Packing
ITEMS Unit of Issue Brand Manufacturer (amount in figures and
Lot Specifications) Origin Unit
words)
No.

Total Cost:

Name of Company/Consignor:
 Name of Authorized Representative
Signature over Printed Name
Date:

Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form No.: MCC-CONC-004
CONSIGNMENT OFFER Revision No.: Ø
Effectivity Date: August 13, 2018

Name of Consignor: __
Address:
Contact No.:

Dear Sir/Madam:
In connection with the Invitation to Consign No.: 03 s. 2019 scheduled on February 21, 2019 for the Consignment of OPTHALMIC LENSES, I/We in conformity with the specification/s
hereunder intend to consign the following:

Item
Unit Price
No. / Description (Complete Country of Sub-Packing
ITEMS Unit of Issue Brand Manufacturer (amount in figures and
Lot Specifications) Origin Unit
words)
No.

Total Cost:

Name of Company/Consignor:
 Name of Authorized Representative
Signature over Printed Name

Date: