Quotation Estimate Optometrist in Indonesia Jakarta –Free Word Template Download with AI

Quotation Estimate

Quotation No.:	QTE/2025/JKT/00472
Date of Issue:	14 June 2025
Valid Until:	14 July 2025 (30 calendar days)
Prepared For:	PT Maju Sejahtera Group – Human Resources Department
Client Address:	Jl. Gatot Subroto No. 88, Jakarta Pusat 10270, Indonesia
Attn:	Mr. Budi Santoso, HR Manager
Service Location:	Indonesia Jakarta – SCBD Branch & On-Site Corporate Facility

1. Scope of Work – Optometrist Services in Indonesia Jakarta

This Quotation Estimate is issued by PT Visi Nusantara Optometry Center, a licensed and accredited Optometrist practice operating in Indonesia Jakarta, to provide comprehensive eye examination and vision care services for the corporate employees of PT Maju Sejahtera Group. The scope encompasses a full range of optometric assessments, diagnostic screenings, and corrective lens prescriptions tailored to the occupational and lifestyle needs of your workforce based in the Jakarta metropolitan area.

2. Itemized Services and Pricing

No.	Description of Optometrist Service	Qty	Unit Price (IDR)	Subtotal (IDR)
1	Comprehensive Optometrist Eye Examination (autorefractometry, visual acuity, intraocular pressure, slit-lamp biomicroscopy, and fundus examination) – conducted at our Indonesia Jakarta SCBD clinic	150 pax	Rp 850,000	Rp 127,500,000
2	On-Site Optometrist Mobile Unit Deployment – full examination suite brought to the client's Jakarta office premises (includes transport, setup, and 2 Optometrist technicians per session)	3 days	Rp 12,000,000	Rp 36,000,000
3	Prescription Lenses – Single Vision (1.56 index, anti-reflective coating, blue-light filter) – per pair, dispensed by our Optometrist team in Indonesia Jakarta	60 pairs	Rp 1,250,000	Rp 75,000,000
4	Prescription Lenses – Progressive / Bifocal (1.60 index, premium anti-reflective coating) – per pair, fitted and adjusted by a senior Optometrist	25 pairs	Rp 2,800,000	Rp 70,000,000
5	Frame Selection & Fitting – curated selection of 200+ frame styles available at our Indonesia Jakarta showroom; includes nose-pad adjustment and temple alignment by the Optometrist	85 units	Rp 450,000	Rp 38,250,000
6	Occupational Vision Screening & Ergonomic Assessment – specialized Optometrist evaluation for screen-based workers (digital eye strain protocol, contrast sensitivity, and binocular vision testing)	150 pax	Rp 350,000	Rp 52,500,000
7	Follow-Up Optometrist Consultation (within 30 days of initial fitting) – includes lens adaptation check, prescription verification, and aftercare guidance	85 pax	Rp 200,000	Rp 17,000,000
8	Annual Vision Health Report & Data Management – compiled by the lead Optometrist; includes anonymized aggregate data, individual prescription records, and recommendations for workplace lighting and screen ergonomics in Indonesia Jakarta	1 lot	Rp 8,500,000	Rp 8,500,000

Subtotal	Rp 424,750,000
VAT (PPN) 11%	Rp 46,722,500
Grand Total	Rp 471,472,500

(Four Hundred Seventy-One Million Four Hundred Seventy-Two Thousand Five Hundred Rupiah)

3. Terms and Conditions

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Any request for services beyond this period will require a revised quotation from our Optometrist team in Indonesia Jakarta.
All prices are quoted in Indonesian Rupiah (IDR) and are inclusive of standard materials. Any additional lens options, premium frame brands, or expedited processing will be subject to a supplementary charge as agreed in writing.
Payment terms: 50% (fifty percent) advance payment upon acceptance of this Quotation Estimate; the remaining 50% (fifty percent) is due within fourteen (14) business days following completion of all Optometrist services and delivery of prescription eyewear.
The Optometrist services will be performed by licensed and registered optometrists (IOWA-registered) in accordance with the standards set by the Indonesian Optometric Association (IOA) and applicable regulations of the Ministry of Health of the Republic of Indonesia.
On-site deployment in Indonesia Jakarta will be scheduled by mutual agreement, with a minimum of five (5) business days' prior notice. Weather-related or force majeure delays will be communicated promptly.
All patient data and prescription records are handled in strict compliance with Indonesia's Personal Data Protection Law (UU PDP No. 27 Tahun 2022). Data will be stored securely and will not be disclosed to third parties without written consent.
This Quotation Estimate does not constitute a binding contract until a formal Service Agreement is executed by both parties. Acceptance may be indicated by signing and returning this document or by issuing a Purchase Order referencing Quotation No. QTE/2025/JKT/00472.
Warranty: All dispensed lenses carry a 12-month manufacturing defect warranty. Frame adjustments by our Optometrist are complimentary for 6 months from the date of fitting.
Any disputes arising from this engagement shall be resolved amicably or, failing that, through the Commercial Court of Jakarta, Indonesia.

Prepared by (Supplier)

Dr. Anisa Wijaya, OMD
Lead Optometrist
PT Visi Nusantara Optometry Center
Indonesia Jakarta

Accepted by (Client)

Mr. Budi Santoso
HR Manager
PT Maju Sejahtera Group
Jakarta, Indonesia ⬇️ Download as DOCX Edit online as DOCX

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