PRIMECORP MEDICAL CENTER LLC {th Flac, Shaikh Saud Bulding (Opp. Reef Mall) PB 7162, Dies, Dubsi - UAE Tet 04-7070000 Fax: - mat: primecore@primeheath 26 TTRN No: 100267778 100003, Tax invoice cast 1 te Patient Name __BHOOPATHI RANDHAM DEVAN RG No. 262727800 Invoice No. aaiesse400 [Address Aout Payer Cosh Invoice Date! Date of supply 1512021 ‘Gender Male Department GENERAL Treating Doctor SELF REQUEST ‘Age » Nationality tna {Figures in AED} ‘S.No [Service Code [Service Description Qty | Unit Rate! Gross| Deductible) Co-Pay| ‘Amount! VAT(%) VAT) Amount | Excluding VAT Including ea pea eee ae say pee __vAT| 1 loves |COVID- 19 PCR TEST - PRIME STAFI 4] 71.43] 71.43| 0.09] 5.00] ‘357| 75.00| Tol: — a | 71.43) 0.00), Hae 7 78.00] ‘Seventy Five Dirhams Te Etre Zi Fae "Refunds 0 per eompany paler Trvaced By" SANJAT SRIDHARAN “This is computer generated ince and dos rt requ signature Settement Details No Date Mode Amount Rose4778 ssi ost 75.00 Total 75.00 Page tof