CASH

RECEIPT

PT. Genomik Solidaritas Indonesia (GSI Lab) DATE

Office:   Graha Mitra, 4th floor March 27, 2021, 6:51 p.m.
        Jl. Jend. Gatot Subroto Kav.21, Jakarta 12930
CASH RECEIPT NO.
Lab:    Jl. RA. Kartini No. 34, Cilandak, Jakarta 12430 1GYMX8XQ24XJL/PDI-100-012-
4618/GSI/III/2021
www.gsilab.id
BOOKING ID
IEG-522-881-6323

PATIENT NAME
Dimas Ramdani Triputra

EMAIL
dimas.ramdani@zuperdrive.com

Description Quantity Unit Price Amount

Rp.
PCR Tests PCR #1solidaritas H+1 (Hasil besok max 23.59) _COVID 19 1 Rp. 699.000
699.000

Rp.
Total
699.000

This receipt is automatically generated by the system hence no signature is required