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Nwah Health Insurance

INVOICE
#1

Date: Dec 13, 2022


Bill To:
Payment Terms: j9hu
a
Due Date: Dec 22, 2022

PO Number: ijiuno

Balance Due: ₹221,800.00

Item Quantity Rate Amount

Ambulance fee 3 ₹4,000.00 ₹12,000.00


Medicine 60 ₹500.00 ₹30,000.00
Room fee 10 ₹4,000.00 ₹40,000.00
Bill fee 10 ₹2,000.00 ₹20,000.00
Entry fee 3 ₹4,000.00 ₹12,000.00
Surgery fee 2 ₹6,000.00 ₹12,000.00
Medical fee 10 ₹18,000.00 ₹180,000.00
Coverage 10 -₹10,000.00 -₹100,000.00
Late fee 10 ₹1,000.00 ₹10,000.00

Subtotal: ₹216,000.00

Tax (5%): ₹10,800.00

Total: ₹226,800.00

Amount Paid: ₹5,000.00

Notes:
j

Terms:
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