4/29/2019 localhost/bonefix/case/print-voucher-form/1

Company Name
Company Address

BFMC - PCSO VOUCHER

Date Control Number Pricing Type
Apr 24, 2019 PCSO-2019-0424-1 AGENT
Agent Surgeon Hospital
CBA Jun Sabayton PGH
SALES INVOICING AND PCSO GUARANTEE LETTER
Hospital Type WH VAT
PCSO 13 % 12 %
Payment Receipt Receipt Number
BILLING SI 11
SI Amount GL Amount GI Number
15,000.00 15,000.00 12

Quantity Item Description Unit Price Amount

2 SET Mini Straight Plate 2.0(Metacarpal) 4 to 8 holes with screws 1 37,500.00 37,500.00
Total Quote Amount 37,500.00

IMPLANT PRICING
Item # Item Description Qty Price Amount
1 Product 2 1.00 600.00 600.00
2 Set 1 1.00 1,000.00 1,000.00
Total Implant Cost 1,600.00

VATable Sales 31,250.00

VAT Amount 3,750.00
LESS: Senior/PWD: 0.00
VAT Exempt Sales: 0.00
ZERO Rated Sales: 0.00
Total Amount Due: 35,000.00
IMPLANT COST AND OTHER CHARGES
Withholding Tax 2,308.19
Implant Cost 1,600.00
Food Allowance 1,500.00
Transportation Allowance 0.00
CPR 0.00
Autoclave Fee 2,040.00
Total Amount Due: 25,841.81
REMITTANCES,EXCESS AND REBATES
VAT Amount 3,750.00 Total Amount Due 35,000.00
Withholding Tax 2,308.19 Remittances -9,698.19
Implant Cost 1,600.00 Surgeon Rebates -10,000.00
Autoclave Fee 2,040.00
CPR 0.00
Remittances 9,698.19 Net 15,301.81

COMMISSION
AGENT OUTSOURCING
Surgeon 10,000.00 Adjustment 0.00 Surgeon 10,000.00 Adjustment 0.00
Commission 2,000.00 - - Commission 2,000.00 - -
Food 1,500.00 - - Food 1,500.00 - -
- - - - Price Difference 400.00 - -
Total Amount 3,500.00 - - Total Amount 3,900.00 - -

localhost/bonefix/case/print-voucher-form/1 1/1