Purchase Order Orthodontist in Indonesia Jakarta –Free Word Template Download with AI
PT. Senyum Sempurna Orthodontic Clinic
Jl. Jend. Sudirman Kav. 52-53, SCBD District, Indonesia Jakarta 12190
Tel: +62-21-520-8899 | Email: [email protected]
NPWP: 01.234.567.8-051.000
Supplier Information| Company Name: | GlobalDental Supply Co., Ltd. |
| Address: | 128 Industrial Park Road, Singapore 638899 |
| Contact Person: | Mr. Tan Wei Ming – Regional Sales Director, Southeast Asia |
| Email: | [email protected] |
| Phone: | +65-6888-4422 |
| Department: | Orthodontist Department – PT. Senyum Sempurna Orthodontic Clinic |
| Receiving Address: | Warehouse 2, Jl. Raya Bogor KM 24, Indonesia Jakarta Timur 13710 |
| Contact Person: | Dr. Ratna Wijaya, Sp.KG (Lead Orthodontist) / Mr. Budi Santoso (Procurement Manager) |
| Phone: | +62-21-520-8899 ext. 204 |
| Item No. | Description | Qty | Unit | Unit Price (USD) | Total (USD) |
|---|---|---|---|---|---|
| 01 | Self-Ligating Orthodontic Bracket System (Aesthetic Ceramic), 16-piece set per arch | 40 | Sets | 185.00 | 7,400.00 |
| 02 | NiTi Archwire, 0.014" to 0.022" x 0.025" (Full Series), per box of 12 | 60 | Boxes | 42.50 | 2,550.00 |
| 03 | Orthodontic Elastomeric Ligatures, Assorted Colors, 1000 pcs per pack | 100 | Packs | 18.00 | 1,800.00 |
| 04 | CBCT (Cone Beam CT) Imaging Scanner, 3D Orthodontic Diagnostic Unit | 1 | Unit | 48,500.00 | 48,500.00 |
| 05 | Orthodontic Forceps and Pliers Set (12 pieces, German Stainless Steel) | 15 | Sets | 95.00 | 1,425.00 |
| 06 | Invisible Aligner Thermoplastic Sheets (BPA-Free), 200 sheets per roll | 25 | Rolls | 320.00 | 8,000.00 |
| 07 | Orthodontic Bonding Agent and Etchant Kit, 500 ml each | 30 | Kits | 28.75 | 862.50 |
| 08 | Digital Intraoral Scanner for Orthodontist Use, 3D Capture, USB-C | 3 | Units | 3,200.00 | 9,600.00 |
| 09 | Orthodontic Headgear and Facebow Components, Pediatric Size | 50 | Sets | 55.00 | 2,750.00 |
| 10 | Composite Resin for Orthodontic Bonding, A2 Shade, 40 g syringe | 80 | Syringes | 12.50 | 1,000.00 |
| Subtotal (USD) | 83,887.50 | ||||
| Import Duty & VAT (11%) – Indonesia Jakarta Customs | 9,227.63 | ||||
| Grand Total (USD) | 93,115.13 | ||||
- This Purchase Order is issued by PT. Senyum Sempurna Orthodontic Clinic, a licensed dental and orthodontic practice registered in Indonesia Jakarta, and constitutes a binding procurement request for the orthodontic equipment and consumables listed above.
- All items must comply with the Indonesian National Agency of Drug and Food Control (BPOM) registration requirements and meet the standards set by the Indonesian Orthodontic Association (PERSI) for use by a practicing Orthodontist in Indonesia Jakarta.
- Delivery shall be made DDP (Delivered Duty Paid) to the receiving warehouse address in Indonesia Jakarta as specified above. The supplier is responsible for all shipping, insurance, customs clearance, and import duties within Indonesia Jakarta.
- Payment shall be made via international wire transfer to the supplier's designated bank account within thirty (30) calendar days from the date of confirmed receipt and inspection of all goods in Indonesia Jakarta.
- The supplier warrants that all orthodontic products are new, unused, and manufactured within the last twelve (12) months. All medical devices must carry valid CE marking and FDA clearance documentation.
- Any discrepancy in quantity, quality, or specification upon delivery in Indonesia Jakarta must be reported to the Procurement Manager within five (5) business days. Defective or non-conforming items will be replaced at the supplier's sole expense.
- This Purchase Order is subject to the commercial laws of the Republic of Indonesia. Any disputes arising from this transaction shall be resolved through arbitration in Indonesia Jakarta under the rules of the Indonesian National Board of Arbitration (BANI).
- The supplier acknowledges that the end-user of all orthodontic materials is a certified Orthodontist (Sp.KG) practicing in Indonesia Jakarta, and all products must be suitable for clinical orthodontic procedures including fixed appliance therapy, clear aligner treatment, and orthognathic surgical planning.
- Partial shipments are not permitted. All line items must be delivered together in a single consignment to the Indonesia Jakarta warehouse to ensure coordinated installation and calibration by the clinic's biomedical engineering team.
- This Purchase Order may not be transferred, assigned, or subcontracted without prior written consent from PT. Senyum Sempurna Orthodontic Clinic, Indonesia Jakarta.
For and on behalf of the Buyer:
PT. Senyum Sempurna Orthodontic Clinic
Indonesia Jakarta
Lead Orthodontist / Director
Date: _______________
For and on behalf of the Supplier:
GlobalDental Supply Co., Ltd.
Mr. Tan Wei MingRegional Sales Director
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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