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Purchase Order Optometrist in Indonesia Jakarta –Free Word Template Download with AI

Jl. Jend. Sudirman Kav. 52-53, SCBD District, Jakarta Selatan, DKI Jakarta 12190, Indonesia

Tel: +62-21-5790-1234 | Email: [email protected]

NPWP: 01.234.567.8-051.000 | Business License (NIB): 1203000000001

Purchase Order

Purchase Order Details

Purchase Order No.: PO/VSJ/2025/00472

Date of Issue: 15 June 2025

Delivery Deadline: 30 June 2025

Payment Terms: Net 30 Days

Currency: Indonesian Rupiah (IDR)

Delivery Location: VisiSehat Optik Clinic, Menara Sudirman Tower 2, Floor 14, Jakarta Selatan, Indonesia Jakarta

Vendor / Supplier Information

Company: PT. Optika Nusantara Supply

Address: Jl. Gatot Subroto Kav. 28, Jakarta Pusat, DKI Jakarta 10270, Indonesia

Contact Person: Budi Santoso, Procurement Manager

Tel: +62-21-5550-8899

Email: [email protected]

NPWP: 02.987.654.3-051.000

Reference: This Purchase Order is issued by PT. VisiSehat Optik Indonesia for the procurement of professional optometry equipment, diagnostic instruments, and optical supplies required for the operation of our Optometrist practice located in Indonesia Jakarta. All items listed below are intended to support the clinical services provided by our licensed Optometrist team in accordance with the standards set by the Indonesian Optometric Association (Ikatan Optometris Indonesia) and the Ministry of Health of the Republic of Indonesia.
No. Item Description Specification Qty Unit Unit Price (IDR) Total (IDR)
1 Auto Refractometer / Keratometer (Digital) Topcon RM-8900 2 Unit 85,000,000 170,000,000
2 Phoropter (Binocular Trial Frame) Nidek NP-200 3 Unit 42,000,000 126,000,000
3 Slit Lamp Biomicroscope Haag-Streit BQ 900 2 Unit 120,000,000 240,000,000
4 Digital Fundus Camera Zeiss Visucam 500 1 Unit 280,000,000 280,000,000
5 Optical Coating Machine (Anti-Reflective) OptiCoat Pro 3000 1 Unit 195,000,000 195,000,000
6 Progressive Lens Blanks (1.67 Index) Essilor Varilux X Series 200 Pairs 1,850,000 370,000,000
7 Single Vision Lens Blanks (1.60 Index) Essilor Crizal Series 500 Pairs 950,000 475,000,000
8 Optical Frames (Designer Collection) Various Brands - Titanium 150 Pairs 2,500,000 375,000,000
9 Contact Lens Fitting Kit (Soft & RGP) Complete Diagnostic Set 5 Set 18,000,000 90,000,000
10 Visual Acuity Chart (LED Illuminated) ETDRS Standard, 6m 4 Unit 8,500,000 34,000,000
11 Perimeter (Goldmann 300) Goldmann 300 Projector 1 Unit 155,000,000 155,000,000
12 Optometrist Examination Chair (Hydraulic) Adjustable, Leather Upholstery 6 Unit 12,000,000 72,000,000

Subtotal: IDR 2,612,000,000

VAT (PPN) 11%: IDR 287,320,000

Shipping & Installation (within Indonesia Jakarta area): IDR 45,000,000

Grand Total: IDR 2,944,320,000

Terms and Conditions

  1. This Purchase Order is valid for acceptance within seven (7) calendar days from the date of issue. The vendor, PT. Optika Nusantara Supply, must confirm acceptance in writing via email to [email protected].
  2. All equipment and optical supplies listed in this Purchase Order must be delivered to the designated address in Indonesia Jakarta no later than 30 June 2025. Late delivery will incur a penalty of 0.5% of the total Purchase Order value per day of delay, capped at 10%.
  3. Payment shall be made via bank transfer to the vendor's designated account within thirty (30) days from the date of confirmed delivery and acceptance of all items by our Optometrist team and technical staff.
  4. All medical and optometric equipment must comply with the Indonesian National Standard (SNI) and must carry valid registration from the Indonesian National Agency of Drug and Food Control (BPOM). The vendor is responsible for providing all necessary certificates and documentation.
  5. The vendor shall provide a minimum of two (2) years warranty on all electronic and mechanical equipment. Warranty service must be available within the Indonesia Jakarta metropolitan area with a response time not exceeding forty-eight (48) hours.
  6. Installation, calibration, and operator training for all major equipment (items 1 through 5 and 11) shall be conducted at our clinic premises in Indonesia Jakarta at no additional cost to the buyer. Training must be provided to our Optometrist staff and clinical technicians.
  7. Any damage discovered upon delivery must be reported within three (3) business days. The vendor shall replace damaged items at their own expense within five (5) business days.
  8. This Purchase Order is governed by the laws of the Republic of Indonesia. Any disputes arising from this Purchase Order shall be resolved through the Commercial Court (Pengadilan Niaga) in Jakarta, Indonesia.
  9. The vendor acknowledges that all items procured under this Purchase Order are intended for use by a licensed Optometrist practice and must meet the professional standards required for clinical eye examination, diagnosis, and corrective lens dispensing in Indonesia.
  10. Partial deliveries are not permitted unless explicitly approved in writing by the buyer's procurement department. All items must arrive in a single shipment to ensure coordinated installation and commissioning.

Prepared By (Buyer):

Sari Wulandari, S.Si
Procurement Officer
PT. VisiSehat Optik Indonesia
Date: _______________

Approved By (Buyer):

Dr. Ahmad Fauzi, M.Sc., AOK
Chief Optometrist / Director
PT. VisiSehat Optik Indonesia
Date: _______________

Accepted By (Vendor):

Budi Santoso
Procurement Manager
PT. Optika Nusantara Supply
Date: _______________

Authorized Signatory (Vendor):

Ir. Hendra Wijaya
Director
PT. Optika Nusantara Supply
Date: _______________

This Purchase Order document (PO/VSJ/2025/00472) is issued by PT. VisiSehat Optik Indonesia, a registered Optometrist practice and optical retail company operating in Indonesia Jakarta. This document constitutes a legally binding agreement upon signature by all authorized parties. For inquiries regarding this Purchase Order, please contact the Procurement Department at [email protected] or call +62-21-5790-1234 during business hours (Monday to Friday, 08:00–17:00 WIB).

© 2025 PT. VisiSehat Optik Indonesia. All rights reserved. Document generated on 15 June 2025.

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