PROFORMA INVOICE

Supplier : Erba Lachema s.r.o. Document No. : 270170013

Karásek 2219/1d Order confirmation: 650170097

621 00 Brno
Czech Republic Customer No. : 1994
ID No. 26918846 Vat No. CZ26918846 Your Order No. :
Entered in the Commercial Register at the Reg.Commercial Court in Brno,
Section C, Riger 45458 Reference No. : EOPI/010/2017 11.1.2017
Telephone : Fax : E-mail :
Bank: CITIBANK, PRAHA Account No.: 2063370307 / 2600 IBAN: CZ1626000000002063370307 BIC: CITICZPX

Delivery address : DISTRITECH Customer: DISTRITECH

26 BP 177 Abidjan 26 26 BP 177 Abidjan 26

Centre TALIA Rue Pierre et Marie CURIE Centre TALIA Rue Pierre et Marie CURIE
* Abidjan * Abidjan
IVORY COAST IVORY COAST
ID No. : VAT No : ID No. : VAT No :
Payment : Payment method :
Date of issue : 11.1.2017 Terms of delivery :
Transport : by air

Terms of payment :

Pos. Material Description

Cat.code EM Unit Total Discount/Surcharge Price adjust. VAT rate TOTAL
Commodity code Quantity Unit price price -/+ % +/- % Tax base % including VAT

Order Confirmation 650170097

1 12000003 HDL C 160
XSYS0043 R1: 4 x 30 ml + R2: 4 x 10 ml
38220000
5,00 PCS 68,40 342,00 342,00 0 342,00
2 12000007 LDL C 80
XSYS0044 R1: 2 x 30 ml + R2: 2 x 10 ml
38220000
2,00 PCS 68,40 136,80 136,80 0 136,80
3 12000009 HDL/LDL CAL
XSYS0061 2 x 1 ml
30029010
2,00 PCS 33,72 67,44 67,44 0 67,44
4 12000010 XL MULTICAL
XSYS0034 4 x 3 ml
38220000
5,00 PCS 31,68 158,40 158,40 0 158,40
5 12000012 ERBA NORM
BLT00080 R1: 4 x 5 ml + R2: 1 x 20 ml
30029010
10,00 PCS 21,60 216,00 216,00 0 216,00
6 12000013 ERBA PATH
BLT00081 R1: 4 x 5 ml + R2: 1 x 20 ml
30029010
10,00 PCS 21,60 216,00 216,00 0 216,00
7 12000016 ALP 110
XSYS0002 R1: 2 x 44 ml + R2: 2 x 11 ml

Issued by : Hana Jelínková

Proforma Invoice : 270170013 Page: 1 / 5
 PROFORMA INVOICE
Supplier : Erba Lachema s.r.o.

621 00 Brno Document No. : 270170013

Pos. Material Description

Cat.code EM Unit Total Discount/Surcharge Price adjust. VAT rate TOTAL
Commodity code Quantity Unit price price -/+ % +/- % Tax base % including VAT

Order Confirmation 650170097

38220000
2,00 PCS 9,36 18,72 18,72 0 18,72
8 12000017 AMY 110
XSYS0003 R1: 5 x 22 ml
38220000
2,00 PCS 33,36 66,72 66,72 0 66,72
9 12000018 CREA 275
XSYS0024 R1: 5 x 44 ml + R2: 5 x 11 ml
38220000
5,00 PCS 8,18 40,90 40,90 0 40,90
10 12000019 GGT 110
XSYS0011 R1: 2 x 44 ml + R2: 2 x 11 ml
38220000
2,00 PCS 12,96 25,92 25,92 0 25,92
11 12000020 CHOL 440
XSYS0009 R1: 10 x 44 ml
38220000 available January 13th
5,00 PCS 21,24 106,20 106,20 0 106,20
12 12000021 LDH 110
XSYS0013 R1: 2 x 44 ml + R2: 2 x 11 ml
38220000
1,00 PCS 7,68 7,68 7,68 0 7,68
13 12000024 UREA 275
XSYS0020 R1: 5 x 44 ml + R2: 5 x 11 ml
38220000
5,00 PCS 13,92 69,60 69,60 0 69,60
14 12000032 BIL D 330
XSYS0028 R1: 6 x 44 ml + R2: 3 x 22 ml
38220000
1,00 PCS 11,40 11,40 11,40 0 11,40
15 12000034 BIL T 330
XSYS0023 R1: 6 x 44 ml + R2: 3 x 22 ml
38220000
1,00 PCS 11,40 11,40 11,40 0 11,40
16 12000038 CA 120
XSYS0007 R1: 10 x 12 ml
38220000
20,00 PCS 11,28 225,60 225,60 0 225,60
17 12000040 CK 110
XSYS0022 R1: 2 x 44 ml + R2: 2 x 11 ml
38220000
2,00 PCS 23,52 47,04 47,04 0 47,04
18 12000042 CK MB 110
XSYS0029 R1: 2 x 44 ml + R2: 2 x 11 ml
38220000
2,00 PCS 42,96 85,92 85,92 0 85,92
19 12000044 CREA 200
BLT00020 R1: 2 x 50 ml + R2: 2 x 50 ml + R3 STD: 1 x 5 ml
38220000
5,00 PCS 5,16 25,80 25,80 0 25,80

Issued by : Hana Jelínková

Proforma Invoice : 270170013 Page: 2 / 5
 PROFORMA INVOICE
Supplier : Erba Lachema s.r.o.

621 00 Brno Document No. : 270170013

Pos. Material Description

Cat.code EM Unit Total Discount/Surcharge Price adjust. VAT rate TOTAL
Commodity code Quantity Unit price price -/+ % +/- % Tax base % including VAT

Order Confirmation 650170097

20 12000048 GLU 500
BLT00025 R1: 2 x 250 ml + R2 STD: 2 x 5 ml
38220000
5,00 PCS 10,80 54,00 54,00 0 54,00
21 12000051 GLU 440
XSYS0012 R1: 10 x 44 ml
38220000
5,00 PCS 12,00 60,00 60,00 0 60,00
22 12000055 CHOL 5x50
BLT00034 R1: 5 x 50 ml + R2 STD: 1 x 3 ml
38220000 available January 13th
3,00 PCS 10,80 32,40 32,40 0 32,40
23 12000063 PHOS 120
XSYS0015 R1: 10 x 12 ml
38220000
2,00 PCS 9,12 18,24 18,24 0 18,24
24 12000065 AST/GOT 250
BLT00050 R1: 4 x 50 ml + R2: 1 x 50 ml
38220000
5,00 PCS 9,60 48,00 48,00 0 48,00
25 12000067 AST/GOT 330
XSYS0016 R1: 6 x 44 ml + R2: 3 x 22 ml
38220000
5,00 PCS 13,08 65,40 65,40 0 65,40
26 12000068 ALT/GPT 250
BLT00052 R1: 4 x 50 ml + R2: 1 x 50 ml
38220000
5,00 PCS 9,60 48,00 48,00 0 48,00
27 12000070 ALT/GPT 330
XSYS0017 R1: 6 x 44 ml + R2: 3 x 22 ml
38220000
5,00 PCS 13,08 65,40 65,40 0 65,40
28 12000074 TG 100
BLT00057 R1: 2 x 50 ml + R2 STD: 1 x 3 ml
38220000
3,00 PCS 10,20 30,60 30,60 0 30,60
29 12000077 TG 440
XSYS0041 R1: 10 x 44 ml
38220000
5,00 PCS 38,04 190,20 190,20 0 190,20
30 12000079 UREA 250
BLT00061 R1: 4 x 50 ml + R2: 1 x 50 ml + R3 STD: 1 x 5 ml
38220000
5,00 PCS 11,01 55,05 55,05 0 55,05
31 12000080 UA SINGLE 200
BLT00062 R1: 4 x 50 ml + R2 STD: 1 x 5 ml
38220000
2,00 PCS 9,60 19,20 19,20 0 19,20
32 12000081 UA 440
XSYS0042 R1: 10 x 44 ml

Issued by : Hana Jelínková

Proforma Invoice : 270170013 Page: 3 / 5
 PROFORMA INVOICE
Supplier : Erba Lachema s.r.o.

621 00 Brno Document No. : 270170013

Pos. Material Description

Cat.code EM Unit Total Discount/Surcharge Price adjust. VAT rate TOTAL
Commodity code Quantity Unit price price -/+ % +/- % Tax base % including VAT

Order Confirmation 650170097

38220000
5,00 PCS 27,36 136,80 136,80 0 136,80
33 12000084 XL WASH
XSYS0066 4 x 100 ml
38220000
20,00 PCS 18,48 369,60 369,60 0 369,60
34 12000135 ASO CAL SH
XSYS0051 1 x 1 ml
38220000
1,00 PCS 18,00 18,00 18,00 0 18,00
35 12000136 CRP CAL SH
XSYS0053 1 x 1 ml
38220000
1,00 PCS 26,40 26,40 26,40 0 26,40
36 12000137 RF CAL SH
XSYS0052 1 x 1 ml
38220000
1,00 PCS 18,00 18,00 18,00 0 18,00
37 12000139 ASO
XSYS0046 R1: 2 x 40 ml + R2: 2 x 10 ml
38220000
2,00 PCS 66,00 132,00 132,00 0 132,00
38 12000143 CRP
XSYS0047 R1: 2 x 40 ml + R2: 2 x 10 ml
38220000
10,00 PCS 36,00 360,00 360,00 0 360,00
39 12000148 HBA1C CAL SET
XSYS0057 4 x 0.25 ml
38220000
1,00 PCS 96,00 96,00 96,00 0 96,00
40 12000149 HBA1C CON H
XSYS0056 1 x 0.25 ml
38220000
2,00 PCS 21,16 42,32 42,32 0 42,32
41 12000150 HBA1C CON L
XSYS0055 1 x 0.25 ml
38220000
2,00 PCS 21,60 43,20 43,20 0 43,20
42 12000151 HBA1C
XSYS0054 R1: 1 x 24 ml + R2a: 1 x 8 ml, R2b: 1 x 4 ml + R3: 2 x 50 ml
38220000
10,00 PCS 117,60 1 176,00 1 176,00 0 1 176,00
43 12000156 MAL
XSYS0083 R1: 2 x 30 ml + R2: 1 x 10 ml
38220000 available beginning February
2,00 PCS 40,80 81,60 81,60 0 81,60
44 12000158 MULTICON L1
BLT20034 1 x 1 ml
38220000
2,00 PCS 12,00 24,00 24,00 0 24,00

Issued by : Hana Jelínková

Proforma Invoice : 270170013 Page: 4 / 5
 PROFORMA INVOICE
Supplier : Erba Lachema s.r.o.

621 00 Brno Document No. : 270170013

Pos. Material Description

Cat.code EM Unit Total Discount/Surcharge Price adjust. VAT rate TOTAL
Commodity code Quantity Unit price price -/+ % +/- % Tax base % including VAT

Order Confirmation 650170097

45 12000160 MULTICON L2
BLT20035 1 x 1 ml
38220000
2,00 PCS 19,20 38,40 38,40 0 38,40
46 12000162 RF
XSYS0048 R1: 2 x 40 ml + R2: 2 x 8 ml
38220000
2,00 PCS 112,80 225,60 225,60 0 225,60
47 50004021 ELITE 5 WASH HEAD A5330
90279050
1,00 PCS 175,50 175,50 175,50 0 175,50
48 50004041 ELITE VALVE 2/2 A504
90279050
4,00 PCS 122,60 490,40 490,40 0 490,40
49 50004041 ELITE VALVE 2/2 A504
90279050
1,00 PCS 122,60 122,60 122,60 0 122,60
50 50004042 ELITE VALVE 3/2 A505
90279050
3,00 PCS 125,60 376,80 376,80 0 376,80
51 50004042 ELITE VALVE 3/2 A505
90279050 available mid/end February
2,00 PCS 125,60 251,20 251,20 0 251,20
52 50004260 ELITE 5 SAMPLE ROTOR
90279050
1,00 PCS 800,00 800,00 800,00 0 800,00
53 52000075 ERBA LYTE Ca REAGENT PACK
REG00012 650 ml STD A + 350 ml STD B
38220000
5,00 PCS 110,40 552,00 552,00 0 552,00
54 00156 Freight charge

1,00 860,00 860,00 860,00 0 860,00

218,00 8 982,45 8 982,45

TOTAL EUR 8 982,45

Exchange rate: 27,0200

Issued by : Hana Jelínková

Proforma Invoice : 270170013 Page: 5 / 5