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 OrderPurchase 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
- 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].
- 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%.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.SiProcurement Officer
PT. VisiSehat Optik Indonesia
Date: _______________
Approved By (Buyer):
Dr. Ahmad Fauzi, M.Sc., AOKChief Optometrist / Director
PT. VisiSehat Optik Indonesia
Date: _______________
Accepted By (Vendor):
Budi SantosoProcurement Manager
PT. Optika Nusantara Supply
Date: _______________
Authorized Signatory (Vendor):
Ir. Hendra WijayaDirector
PT. Optika Nusantara Supply
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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