Purchase Order Ophthalmologist in Thailand Bangkok –Free Word Template Download with AI
Ophthalmologist Professional Services & Ophthalmic Equipment Procurement
Buyer (Purchasing Entity)
Chulalongkorn Vision Care Centre
1033 Phahonyothin Road, Pathumwan
Bangkok 10330, Thailand
Tax ID: 0105558123456
Contact: [email protected]
Phone: +66 2 256 4000
Supplier (Ophthalmologist Provider)
Dr. Ananda Siriwat, MD, FACS
Certified Ophthalmologist – Bangkok Eye Institute
288 Sukhumvit Road, Khlong Toei
Bangkok 10110, Thailand
Medical License No.: 1234567 (Thailand)
Contact: [email protected]
Phone: +66 2 251 8899
Line Items – Ophthalmologist Services & Equipment
| # | Description | Category | Qty | Unit Price (THB) | Total (THB) | Delivery |
|---|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmologist Consultation & Diagnostic Eye Examination (per patient session) | Professional Service | 120 | 3,500.00 | 420,000.00 | July 2025 |
| 2 | Advanced Ophthalmologist-Led Cataract Surgery (Phacoemulsification with IOL Implantation) | Surgical Service | 45 | 45,000.00 | 2,025,000.00 | Aug 2025 |
| 3 | Ophthalmologist Supervised LASIK / Refractive Laser Surgery Package | Surgical Service | 30 | 55,000.00 | 1,650,000.00 | Sep 2025 |
| 4 | OCT (Optical Coherence Tomography) Imaging System – Zeiss Cirrus HD-OCT 5000 | Equipment | 1 | 2,850,000.00 | 2,850,000.00 | Jul 2025 |
| 5 | Phacoemulsification Machine with Dispersion Module – Alcon Infiniti | Equipment | 2 | 1,200,000.00 | 2,400,000.00 | Jul 2025 |
| 6 | Topographic Mapping System for Ophthalmologist Pre-Operative Assessment | Equipment | 1 | 980,000.00 | 980,000.00 | Aug 2025 |
| 7 | Annual Maintenance & Calibration Contract for All Ophthalmic Equipment (Ophthalmologist-Approved) | Maintenance | 1 | 320,000.00 | 320,000.00 | Annual |
| 8 | Ophthalmologist Continuing Medical Education & Certification Renewal (Thailand Medical Council) | Professional | 1 | 85,000.00 | 85,000.00 | Jun 2025 |
| Subtotal | 10,730,000.00 THB |
| VAT (7%) – Thailand Revenue Code | 751,100.00 THB |
| Installation & Logistics (Bangkok Metro Area) | 145,000.00 THB |
| Grand Total | 11,626,100.00 THB |
Terms & Conditions
- This Purchase Order is issued by Chulalongkorn Vision Care Centre, Bangkok, Thailand, and is directed to the named Ophthalmologist supplier for the provision of professional ophthalmic services, surgical procedures, and specialized ophthalmic equipment as itemized above.
- All services rendered by the Ophthalmologist shall comply with the standards set forth by the Thai Medical Council and the Food and Drug Administration (FDA) of Thailand. The Ophthalmologist must maintain a valid medical license registered in Thailand Bangkok throughout the duration of this Purchase Order.
- Payment terms: 50% advance payment upon acceptance of this Purchase Order; 40% upon completion of all surgical and consultation services; 10% upon final equipment installation, calibration, and sign-off by the Ophthalmologist in Bangkok.
- Payment shall be made via bank transfer to the supplier's designated account in Thai Baht (THB) within 30 days of invoice receipt. All transactions are subject to Thai tax regulations and VAT compliance.
- Delivery of all ophthalmic equipment shall be made to the Chulalongkorn Vision Care Centre facility located in Pathumwan, Bangkok, Thailand. The Ophthalmologist or their authorized representative shall oversee installation and initial calibration in Thailand Bangkok.
- The Ophthalmologist guarantees a minimum of 12 months of warranty on all surgical outcomes and 24 months on all capital equipment. Any defects or complications arising within the warranty period shall be addressed at no additional cost to the Buyer.
- Confidentiality: All patient data, surgical records, and proprietary Ophthalmologist techniques shared under this Purchase Order shall remain strictly confidential in accordance with Thailand's Personal Data Protection Act (PDPA) B.E. 2562 (2019).
- Force Majeure: Neither party shall be liable for delays caused by natural disasters, government mandates, or public health emergencies affecting operations in Thailand Bangkok, provided written notice is given within 48 hours.
- Dispute Resolution: Any disputes arising from this Purchase Order shall be resolved through mediation under the rules of the Bangkok International Arbitration Centre (BIAC) before proceeding to litigation in the competent courts of Bangkok, Thailand.
- This Purchase Order becomes effective upon written acceptance by both parties and remains valid until 15 July 2025 unless extended by mutual written agreement.
Chulalongkorn Vision Care Centre
Name: _________________________
Title: Procurement Director
Date: _________________________ Authorized Signatory – Ophthalmologist
Bangkok Eye Institute
Name: Dr. Ananda Siriwat, MD
Title: Lead Ophthalmologist
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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