Bill of Supply

Token No. : RDA0003

Patient Name : Mrs. MANJU RANI
Age/Sex : 49 years / Female Bill Date : 20/4/2019 11:30AM
Address : SECTOR 4C, FLAT NO 4123,VASUNDHARA
Max Id : VSLI.117346
Referred By : SELF Bill No : VACS546502
Company GSTN Receipt No : VARC550036
Company Name DGEHS - VSH GSTN Bill No : VACS1718B0147907
GSTN No : 09AACCC4239Q1Z6
Company Address
State(Code) : Bihar -( 10)

SLN SERVICES SAC Qty Base Tariff Discount Net Tax Bill Amount
Price Price Amount Amt (Rs.)
(Rs.) (RS.) (Rs.) (Tax %)
1 Amit Varma 99931 1 600.00 150.00 0.00 150.00 150.00
(Consultation)
(Dermatologist
) ()
Total : 0.00 150.00 0.00 150.00

Paid by Patient : 150.00

Amount in Words : Rupees one hundred fifty only collected from patient
Sum of Rs. 150.00 received with thanks from Mrs. MANJU RANI

( Amount includes discount (if any) as per Agreement )

Payment Mode(s)
Cash for Rs.150.00

Signature of Patient/Next of Kin Signature

KIRAN PATWAL

Place of Supply : Uttar Pradesh-(09)

Company Name : Max Super Speciality Hospital- Vaishali (A unit of Crosslay Remedies Ltd.)
PAN No. : AACCC4239Q