CONSIGNMENT AGREEMENT

FOR [insert the Consigned Items Needed]

OF THE [Name of the End-User Unit]

This Consignment Agreement is entered into by and between;

The [insert name of the Consignor in all caps], a sole proprietorship/corporation/partnership
(choose one, delete others), with office address at [insert address of the Consignor], Philippines,
represented herein by its [insert the position and the name of the authorized representative of the
Consignor], and hereinafter referred to as the CONSIGNOR/S;
- and -
The UNIVERSITY OF THE PHILIPPINES, the national university of the Philippines, a public
and secular institution of highest learning, created by virtue of Act No. 1870, as amended and
reorganized and operating by virtue of Republic Act No. 9500, through its constituent university,
University of the Philippines Manila through the PHILIPPINE GENERAL HOSPITAL (PGH),
with address at the Office of the Director, Ground Floor, Philippine General Hospital Complex,
Taft Avenue, Manila, represented by the PGH Director, GERARDO D. LEGASPI, M.D. and
hereinafter referred to as the CONSIGNEE.

WITNESSETH THAT;
WHEREAS, in view of the high demand of drugs and medicines , which must be always
available, however, access to the same by patients and other common people has been limited;
WHEREAS, the Consignor desires to offer its product at a reasonable cost through
forward-stocking or consignment scheme;
WHEREAS, the Consignor was among those specifically identified in the list determined
by the Hospital Consignment Committee (HCC) as having the most responsive and reasonable
price offer based on the invitation;
NOW THEREFORE, for and in consideration of the foregoing premises, and the terms
conditions hereunder enumerated, the parties this Agreement hereby agree, that:
1. The Consignor shall undertake to supply DRUGS AND MEDICINES /
MEDICAL SUPPLIES for sale on a consignment basis at the [insert name of the
Consignee or the end-user] or equivalent project/unit of the Consignee. A
Consignment Order shall be issued for this purpose. The said Consignment Order
shall be made an integral part of this Agreement.

The Consignment Order shall contain the specific description and quantities of the
medical device/implant to be delivered by the Consignor. Delivery Receipt will
accompany each delivery of items with the following information:
a. Name of Consignor as Heading
b. Date of Delivery Receipt
c. Delivery Receipt No.
d. Consignment No.
e. Name of authorized representative of the Consignor effecting the delivery
f. Item No.
g. Description of the Article
i. Batch No. / Lot No.
ii. Manufacturing date
h. Quantity
i. Unit
j. Unit Price
 k. Total Price

2. Deliveries will be inspected by the representative of the [insert name of the

Consignee or the end-user] as End-User and / or the Inspection and Acceptance
Committee. The Inspection Report shall be one of the requirements for payment.
Nothing on this agreement shall be construed to signify a sale transaction between
the Consignor and Consignee upon the delivery of the consigned items.

3. The Consignee shall undertake to sell the consigned items to the public at a
reasonable and affordable price including those requiring support from other
government agencies (e.g. PCSO), when applicable.

4. The Consignee shall keep/maintain separate inventory records, which shall not
form part of the live inventory of the consignee, using stock cards or subsidiary
ledger showing receipts, issuances and balances, to facilitate the monthly inventory
taking and verification/processing of payments.

5. The Consignee through its authorized representative of the [insert name of the
Consignee or the end-user] shall prepare a Sales Report (SR) indicating the total
stocks sold for invoicing of the Consignor. The SR shall be received by the
Consignor’s Authorized Representative within three days (3) days after the
consigned items are sold, and based on the SR, the Consignor shall issue a
corresponding Sales Invoice (SI).

6. The consignee agrees to remit the sales proceeds to the consignor fourteen (14) days, after
receipt of any of the following whichever is applicable:

(a) Receipt by the consignee of the funds from the funding agency/ies;
(b) Receipt by the consignee of the patient’s payment.

7. No items shall be received with expiration dates that are less than twelve (12)
months from the date of delivery, unless certified by the respective end-user
Department.

8. The Consignor holds the Consignee free from any liability for the consigned items
except for failure to reasonably protect these consigned items from pilferage and
theft. Any loss arising from fortuitous event shall relieve the Consignee from any
liability.

9. The Consignor shall be bound to maintain the price of the consigned items during
the effectivity of this agreement.

10. Upon expiration of this AGREEMENT, all unconsumed stocks in original

packaging shall be returned to the Consignor who shall remove from the Consignee
the said stocks within fifteen (15) days from the termination of this Agreement.

11. The Consignor warrants that no article or product covered under this
AGREEMENT is adulterated or misbranded within the meaning of the Food, Drug
and Cosmetic Act, as amended, and/or other applicable laws.

12. The Consignor warrants that the consigned medical device/implant is safe, free
from defects and has been issued a Certificate of Product Registration (CPR) by the
Food and Drug Administration – Philippines and/or by the Bureau of Health
Devices and Technology (BHDT) of the Department of Health.

13. The Consignor shall hold the Consignee free and harmless from, and shall be solely
responsible for any claim, action, suit, cost of expenses, damages and liabilities
arising out of, in connection with or resulting from the use of the consigned items.

14. The Consignor further warrants that all products or articles covered under this
AGREEMENT are free from lien or encumbrances from third parties.
 15. This AGREEMENT shall be binding and effective upon approval of both parties,
from ________ to ________ [insert date], but may be terminated earlier by any of
the parties upon thirty (30) days prior written notice.

16. This AGREEMENT will automatically renew the obligation to perform said service
for a successive term of one (1) year following the expiration of the agreement,
under the same terms and conditions set forth herein, subject to performance
evaluation, unless terminated by either party upon delivering written notice to the
other party at least thirty (30) days prior to the end of the then existing term.

17. The Terms of Reference is hereby attached as integral part of this contract, which
shall be binding to both contracting parties.

18. Parties agrees to resort to Alternative Dispute Resolution (ADR) or any possible
legal remedies in order to settle any dispute, controversy or claim arising out of or
relating to this agreement in accordance with the rules of arbitration contained in
the UNCITRAL Model Law as adopted in Republic Act No. 9285 or the ADR Law
of 2004

IN VIEW THEREOF, the parties have hereunto set their hands this ____ day of
______________________, ________.

CONSIGNOR CONSIGNEE
BY: BY:

GERARDO D. LEGASPI, M.D.

Sales Manager PGH Director

WITNESSES:

MA. MARGARITA LAT LUNA, M.D. JULIET SIO-AGUILAR, M.D.

Deputy Director for Fiscal Services Chair, PGH – Consignment Committee

______________________________
Chair – Department of ____________________________
 ACKNOWLEDGEMENT

Republic of the Philippines)

) S.S.

BEFORE ME, a Notary Public, for and within ______________, on this

_______________ of _________________, _______ personally appeared the following:

Name CTC Issued at Issued on

1. GERARDO D. LEGASPI, M.D. ____________ ____________ ____________

2.________________________ ____________ ____________ ____________

known to me and to me known to be the same persons who executed the foregoing instrument and
having acknowledged before me that it is their own, free and voluntary act and deed.

This instrument consisting of four (4) pages, including this page, in which the
acknowledgment portion is found, signed by both parties concerned, and their instrumental
witnesses on each and every page on the left margin thereof.

IN WITNESS WHEREOF, I have hereunto set my hand, the day, year and place above
written.

NOTARY PUBLIC

Doc. No. ________________

Page No. ________________

Book No ________________
Series of ________________