E & E Industrial Complex Narra Road, Brgy.

San Antonio, San Pedro, Laguna

Tel#556-7686/556-7949 Telefax#556-8302

sales ORDER FORM

CUSTOMER NAME : ZONE
CUSTOMER NO. : PMR NAME
COMPLETE ADDRESS : DATE
TERMS
TEL# : DISCOUNT ( pls check)

PRIMARY & CV METABOLIC CARE FREE UNIT

QTY

PACKING AMOUNT CHILD CARE PRODUCTS

PRODUCTS GOODS PRICE
ALLURASE 100 mg tablet 100s 515.20 ANALCID 50mg / 5ml susp.
ALLURASE 300mg tablet 50s 672.00 ASFRENON 2mg / 5mL syrup
ANALCID 500mg tablet 100s 650.00 ASFRENON GF EXPECTORANT
ASFRENON 2mg tablet 100s 330.00 ASFRENON GF EXPECTORANT
AZTHROCIN 250mg tablet 10s 500.00 BIO-TERMIN AS syrup
BETAVIT tablet 60s 750.00 BIO-TERMIN AS syrup
CARDITEC 50mg tablet 100s 347.20 BIO-TERMIN PLUS SYRUP W/ LE
CENTRAVIM tablet 100s 1,031.58 BIO-TERMIN PLUS SYRUP W/ LE
CLOXIM 15mg tablet 30s 675.00 BIO-TERMIN PLUS SYRUP W/ LE
C-PHENICOL 500mg capsule 100s 1,008.00 C-4-KIDS DROPS 100mg
COGEL SOFTGEL capsule 50s 350.00 C-4-KIDS 100mg / 5ml
DISOFLEM 500mg capsule 100s 782.96 C-PHENICOL 125mg / 5mL
EBUTOL FORTE tablet 100s 937.44 DISOFLEM 100mg / 5mL
FOLIAGE 5 mg tablet 100s 520.00 EBUTOL SYRUP
KLARYZ 500mg tablet 30s 1,500.00 HERSOLIN 290 mcg / 5mL
LANZEP 30mg capsule 100s 1,800.00 H - ONE 10mg tablet
MUCOSOLIN 30mg tablet 100s 547.68 H-ONE 1mg / ml oral solution
MUCOTUSS FORTE capsule 100s 601.92 KLARYZ 125mg / 5ml GFS
QUALISTAT 20 mg. tablet 100's 1,300.00 MUCOSOLIN 15mg / 5mL
QUALISTAT 40 mg. tablet 100's 1,675.00 MUCOTUSS SYRUP
QUALISTAT 80 mg. tablet 100's 3,000.00 MUCOTUSS SYRUP
SG-GLUTERGEN capsule 60s 915.20 PYRAMIN 250mg / 5mL SUSP
SUCRON 5 mg tablet 100s 635.25 PYRAMIN 250mg / 5mL SUSP
SUPREX 800mg / 160mg tablet 100s 1,120.00 REFAM 200mg / 5mL SUSP.
TERAMOL 500mg tablet 100s 210.98 REFAM 200mg / 5mL SUSP.
TERAMOL 600mg tablet 100s 219.52 REFAM DUO VALUE PACK
TERRAFERRON capsule 100s 700.00 REFAM DUO
TERAMOXYL 500 mg capsule 100s 1,223.20 REFAM DUO
TERAVOX 500 mg tablet 50's 2,850.00 REFAM DUO
TERMIN-C capsule 100s 584.43 REFAM PEDIA KIT VALUE PACK
TRICOMYCIN 500 mg tablet 100s 1,100.00 REFAM PEDIA KIT
VASCAR 5mg tablet 100s 950.00 SUPREX 200mg / 40mg / 5mL SUS
VASCAR 10mg tablet 100s 1,300.00 SUPREX 200mg / 40mg / 5mL SUS
VIACEF 500mg tablet 100s 6,500.00 TERAMOL 100mg / mL INFANT DR
XINFLEX 500mg capsule 100s 2,286.90 TERAMOL 120mg / 5mL SYRUP
XIPRO 500mg tablet 100s 3,400.00 TERAMOL 250mg / 5mL FORTE S
TERAMOXYL 100mg / mL INFANT
TERAMOXYL 125mg / 5mL SUSP.
TERAMOXYL 250mg / 5mL SUSP.
TERAMOXYL 250mg / 5mL SUSP.
TEROZID FORTE SYRUP
TEROZID FORTE SYRUP
VAMOX 250mg/62.5mg/5ml
VAMOX 400mg/57mg/5ml
XINFLEX 100mg / mL INFANT DR
XINFLEX 250mg / 5mL SUSP
XINFLEX 250mg / 5mL SUSP
TOTAL TOTAL

NOTE : PRICES ARE INCLUSIVE OF 12% VAT

CUSTOMER HISTORY
CREDIT LIMIT = PhP _________
WITH HISTORY OF BOUNCED CHECK = YES NO
NEW CUSTOMER = YES NO

OVERDUE ACCOUNTS:
DATE INVOICE NO. AMOUNT

Freight charges of 8% shall be for the account of the client for returns due to erro

Customer's Signature PMR/DSM Signature

 as of 10/1/2010

Laguna

:
:
:
:
CIS PROMO for GCB's Approval

FREE UNIT
QTY

PACKING AMOUNT
GOODS PRICE
60ml 82.50
60ml 75.87
60ml 91.84
120ml 159.50
60ml 110.88
120ml 168.00
60ml 75.31
120ml 121.33
250ml 214.72
15ml 50.00
120ml 102.30
60ml 101.07
60ml 67.20
120ml 113.12
60ml 165.76
100s 1,600.00
30ml 118.00
50ml 428.00
60ml 68.32
60ml 56.68
120ml 90.42
60ml 80.64
120ml 112.00
60ml 188.50
120ml 356.50
120ml 464.80
60ml 188.50
120ml 356.50
250ml 661.31
60ml 320.00
60ml 241.50
60ml 96.76
70ml 119.84
15ml 61.11
60ml 52.06
60ml 72.80
10ml 72.60
60ml 78.10
60ml 117.70
105ml 174.90
60ml 59.36
120ml 77.28
60ml 275.00
70ml 450.00
10ml 116.06
60 ml 204.96
70 ml 241.92
 STATUS/FEEDBACK

e to erroneous booking.

Approved by:
 SAE #

Life Within
Life Within
E & E Industrial Complex, Brgy. San Antonio,
San Pedro, Laguna Tel#:556-7946/556-7950
Reach
Telefax#:556-7689/556-8302
Reach SUMMARY OF ALLOWED EXPENSES
Name:
Position: PMR District: MINDANAO 2 Period Covered:
Home Base: DAVAO CITY Zone: Date Submitted:

Mon Tue Wed Thur Fri Sat Sun TOTAL

date
Areas Covered
Particular
1. MEALS - Breakfast
- Lunch
- Dinner
2. TRANSPORTATION
3. GASOLINE - Amount
km. run
4. LODGING
5. COMMUNICATION
- Cellcards
- Fax
- Mailings
- Internet/pc rental
6. photo copy / PRINTING
7. TOLL/PARKING/TERMINAL
8. CAR EXPENSES (minor)

(change oil,vulcanize,tune-up etc)

9. OTHER EXPENSES (specify)

TOTAL OPEX
* Please attach supporting invoices to each DCR before attaching all DCRs to this report. * km run x cost per liter / factor
Submitted by: Checked/Reviewed by:

_____________________________
Printed Name & Signature/Date Printed Name & Signature/Date
Endorsed by: Approved for payment by:

SHARON MARIE Q. ABRINA _____________________________

Printed Name & Signature/Date Printed Name & Signature/Date
 E & E Industrial Complex, Brgy. San Antonio,San Pedro, Laguna
Telefax#:556-7689/556-8302 email: tmi@terramedic.com.ph

DAILY CALL REPORT

SAMPLES AND PROMATS GIVEN
PMR: DATE:

DISTRICT: AREA OF COVERAGE:

MD'S NAME SPECIALTY LOCATION SIGNATURE

10

11

12

13

14

15
BEGINNING BALANCE
PMR SIGNATURE: TOTAL SAMPLES/PROMATS GIVEN
 ENDING BALANCE
DSM SIGNATURE:
 E & E Industrial Complex Narra Road, Brgy. San Antonio, San Pedro, Laguna
Tel#(02)-556-7946/556- 7650 Telefax#(02)556-8302/556-7689

REQUISITION FORM

SAMPLE ✘ STOCK SIZE PROMATS

NAME:______________________________ DATE:_____________________
POSITION:____________________________ DISTRICT:__________________

PRODUCT QUANTITY REASON FOR REQUEST

1
2
3
4
5
6
7
8
9
10

REQUESted by: Checked by:

_____________________________ _____________________________
printed Name & Signature/Date Printed Name & Signature/Date

ENDORSed by: Approved by:

_____________________________ _____________________________
printed Name &Signature/Date PRINTED Name & Signature/Date

E & E Industrial Complex Narra Road, Brgy. San Antonio, San Pedro, Laguna
Tel#(02)-556-7946/556- 7650 Telefax#(02)556-8302/556-7689

REQUISITION FORM

SAMPLE STOCK SIZE PROMATS

NAME:______________________________ DATE:_____________________
POSITION:____________________________ DISTRICT:__________________

PRODUCT QUANTITY REASON FOR REQUEST

1
2
3
4
5
6
7
8
9
10

REQUESted by: Checked by:

_____________________________ _____________________________
printed Name & Signature/Date Printed Name & Signature/Date

ENDORSed by: Approved by:

_____________________________ _____________________________
printed Name &Signature/Date PRINTED Name & Signature/Date
 E & E Industrial Complex, Brgy. San Antonio, FUND REPLENISHMENT STATEMENT
San Pedro, Laguna Tel#:(02)556-7946/556-7950 For expense from __________ to ________
Telefax#:(02) 556-7689/556-8302
Fund Name: _________________________________ FRR Number: _____________________
Fund Amount: _________________________________ Date Submitted: _____________________

Inv. Invoice Name of Name of

Item Amount Purpose
Date No. Client PMR

TOTAL

Submitted by: Reviewed by: _________________________

________________________________
(Signature over printed name)
Approved by: __________________________
Name : _________________________________ District : _______________________________

Position : _______________________________ Zone : _________________________________

 FORM 1

STATEMENT
________

_____
_____

Signature of
PMR

_______

______
_____

_______
 FORM 2

E & E Industrial Complex, Brgy. San Antonio, FUND LIQUIDATION STATEMENT

San Pedro, Laguna Tel#:(02)556-7946/556-7950 As of __________________
Telefax#:(02) 556-7689/556-8302
Fund Name: _________________________________ Fund Amount _______________________
Custodian: _________________________________ Voucher# _______________________
Position: _________________________________ Date Issued _______________________

Inv./OR Invoice/OR Name of Name of Signature of

Item Amount Purpose
Date No. MD's PMR PMR

TOTAL

Submitted by: Reviewed by: __________________________

________________________________
(Signature over printed name)
Approved by: __________________________
 Life Within
Life Within
E & E Industrial Complex, Brgy. San Antonio,
San Pedro, Laguna Tel#:556-7946/556-7689
Reach
Reach
***MEDICAL REIMBURSEMENT***

NAME: DATE:
DEPARTMENT: DATE RECEIVED

Please reimburse the amount of

(Php ) for my ( ) medicine ( ) Doctor’s fee ( ) others, please specify
as part of my medical assistance plan benefit.

Note: Please attach Doctor’s prescription with Original Receipt & Medical Certificate.

REQUESTED BY: APPROVED BY:

EMPLOYEE'S SIGNATURE ADMINISTRATIVE MANAGER

CHECKED BY: NOTED BY:

HR STAFF NATIONAL SALES MANAGER

---------------------------------------------------------------------------------------------------------------------------------------------------------------

Life Within
Life Within
E & E Industrial Complex, Brgy. San Antonio,
San Pedro, Laguna Tel#:556-7946/556-7689
Reach
Reach
***MEDICAL REIMBURSEMENT***

NAME: DATE:
DEPARTMENT: DATE RECEIVED

Please reimburse the amount of

(Php ) for my ( ) medicine ( ) Doctor’s fee ( ) others, please specify
as part of my medical assistance plan benefit.

Note: Please attach Doctor’s prescription with Original Receipt & Medical Certificate.

REQUESTED BY: APPROVED BY:

EMPLOYEE'S SIGNATURE ADMINISTRATIVE MANAGER

CHECKED BY: NOTED BY:

HR STAFF NATIONAL SALES MANAGER
 Life Within
Life Within
E & E Industrial Complex, Brgy. San Antonio,
San Pedro, Laguna Tel#:556-7946/556-7689
Reach
Reach
***LEAVE APPLICATION FORM***

NAME : DATE FILED :

DEPT/DISTRICT : DATE OF LEAVE :

VACATION PATERNITY
LEAVE BIRTHDAY LEAVE
LEAVE
SICK LEAVE MATERNITY
OTHERS:
LEAVE
REASON:

WITH PAY WITHOUT PAY

VL SL
Total accumulation leave
# of leave taken
Balance to date

REQUESTED BY: APPROVED BY:

EMPLOYEE'S SIGNATURE ADMINISTRATIVE MANAGER

NOTED BY: NOTED BY:

DISTRICT SALES MANAGER NATIONAL SALES MANAGER

RECEIVED BY:
PAYROLL STAFF
----------------------------------------------------------------------------------------------------------------------------------------------------------------

Life Within
Life Within
E & E Industrial Complex, Brgy. San Antonio,
San Pedro, Laguna Tel#:556-7946/556-7689
Reach
Reach
***LEAVE APPLICATION FORM***

NAME : xyzah e. manales DATE FILED : 2-Nov-17

DEPT/DISTRICT : mindanao 2 DATE OF LEAVE : 2-Nov-17

VACATION PATERNITY
LEAVE BIRTHDAY LEAVE
LEAVE
SICK LEAVE MATERNITY OTHERS:emergency leave
LEAVE
REASON:
FEVER AND CHILLS.

WITH PAY WITHOUT PAY

VL SL
Total accumulation leave
# of leave taken
Balance to date

REQUESTED BY: XYZAH ERMAC MANALES APPROVED BY:

EMPLOYEE'S SIGNATURE ADMINISTRATIVE MANAGER

NOTED BY: NOTED BY:

DISTRICT SALES MANAGER NATIONAL SALES MANAGER

RECEIVED BY:
PAYROLL STAFF
-------------------------
 JOB ORDER

Life Within NUMBER:

___________________________

Life Within
E & E Industrial Complex, Brgy. San Antonio, DATE :___________________________

Reach
San Pedro, Laguna Tel#:556-7946/556-7689

Reach
CAR DETAILS
Plate No:___________________________
ENGINE No.:_________________________
Color:_____________________
Make :____________________________ SERIAL No.;_________________________
Mileage____________________
Request for: __ Spare Parts __ Repair __ Body Painting __ Others: _________________
Problem Evaluation / Initial Assessment of Work to be done;

CANVASS / QUOTATION ANALYSIS

SUPPLIER
Materials Required Recommended

SUB TOTAL
LABOR
TOTAL
Remarks: Please Attached Supporting Quotations, with contact persons and numbers

WORK DONE
Date Killometer Run Description Supplier Cost

Amount Advance____________________ Voucher No.:_________________________ Date:______________________

(Returned*) / For Payment_____________*Attach deposit slip or Official Receipt

Car Assignee: _________________________________________

Reviewed By: _________________________________
Name & Signature / Date Name & Signature / Date

Noted By: ____________________________________________

Approved By: _________________________________
Name & Signature / Date Name & Signature / Date
 ACKNOWLEDGEMENT RECEIPT
J.O. No.: ___________________
Received By: ________________________________Date: ____________________
________
 TERRAMEDIC INC.
CASH DISCOUNT FORM
Date:

CUSTOMER SI DATE SI NO. OR NO. SI AMOUNT % DISCOUNT/DEAL

TOTAL

Recipient/s of Rebates :

Remarks, if any :

Submitted by: Reccomnded by:

Reynante Balista
PMR's Name & Signature DM / RSM
NO. ______________

DISCOUNT AMOUNT

0.00

Checked & Verified By:

Marketing Support Staff

Approved by:

Managing Director