JODHPUR SAHAKARI UPBHOKTA WHOLESALE BHANDAR LTD.

JODHPUR

Medical Diary No.

1. Name and PPO no. of Pensioner SATISH CHANDRA SHARMA 1050423 (R)
2. Name of patient and relationship with pensioner SELF
3. Address of pensioner with telephone No. 86, BHANU BANGLOWS, NAYAPURA LALSAGAR, JODHPUR
Telephone No. / Mobile No. 9414384793
4. Name of the shop issued NAC: Jodhpur Sahakari Upbhokta Wholesale Bhandar Ltd Medical sec Counter Mandor
5. NAC No. & Date 7584 dated 29-09-2020
6. Details of Medicines purchased
S. Cash Date Name of Medical Name of Medicine Tab/Cap Quantity Amount
No Memo Shop /Syp ₹
. No.
1 44896 01-12-20 SHIV MEDICAL DIAMICRON XR MEX TAB 60 930.00
HALL, MANDOR

TOTAL 930.00
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irk--------------86, BHANU BANGLOWS, NAYAPURA LALSAGAR, JODHPUR ---------------------
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(for Office use only)
Passed for Rs------------------(in words Rs---------------------------------------------------------------------)
Entered in Register at S. No. ---------------Date-------------------------------------
Name of Shop-------------------------------------------------------------------------------- Signature of Salesman

7. Received sum of ₹ 930.00 (in words—₹ NINE HUNDRED THIRTY ONLY ) an amount of
medicines purchased from private medical shop against the above NAC issued by CONFED shop.

Signature of Pensioner/
Authorized recipient
8. Progressive Total of Expenditure--------------------------------
Previous Total -----------------------------------------------------
Amount of the Claim-----------------------------------------------
Grand total----------------------------------------------------------

Checked and Verified Signature of Salesman

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