3.: 903, Ground Floor, VAIDYA JAGJIT SINGH BAM, | Member: rose acters asa a Facer areca itn ert 41.; House No, 2003/9, Sector 32-C, Chandigarh 160.030 2, :#1701, GF. Sector 22-B, Chandigarh 160 022 Dashmesh Colony, Adjoining Fi Foe Chan, Ber LIVE NATURAL LIVE AYURVEDA a — Sex: I’ Date: A eo eases Name: ie Td eee d Days: Patient ID; ‘Ayurvedic Nidan Prakruti- Ov CP CK DVP TPKOVK CvEK Eran cols coup CT Maperonvon anneae Rneamatont Paras a nese Smoluer Acne Lest Osorio Follow us on “Shae Gchendgatayuned Pracreayves Becac aye Q prswest comacayurveda WaT yorde conenanagarrag.rved jo Fpl ful Diagnosis: Tojo ia ie fH Lael Next visit | > ext Visit Nextvist stunned yt | AYURVEDA TREAT ROOT CAUSE OF ADISEASECHANDIGARH (CHANDIGARH CHANDIGARH: 160047 Contact No.:0876980600 E NET TABLET NERVE UP TABLET Liver CARE \ Pus, POWDER DETOX | (PREMIUM R 80012 450.01 30 480012 520 30 38.0012 1050 ‘SYRUP [PURAN ‘ 140.0032 peo | [ PPACHAK Return Product . ‘H8C_CODE|TEM_HO_COOE! GROUP_jaMeiTAK.2_P RAT Net Sale City 154] Gross Amount] 3725 00| ISGST Tax in 7] [GST Tax "172.78] Round Off 0.03] Final Bil Amount 3725.09 * Fina’ Bill Value incusive ofGST Tender Details [Cash Ameunt |¢Gst| s@st | Total | 172.78 | 345.56 No Cash refunds @/or Credit Noies: are ‘sued in eny case ‘Thank you for Visit with us.ment Glaim Form For Guidoor Treatment Medica! Reimburse! lor Number angantnegcg002e7 1071 4, Name OF Employee 2, Designation 3. Basie Ray + DA (as on-11-04-2023) 4, Plaoe OF Duty Annexure: GtoL Order ht. 22 April 2008) Personnel Number oasateee RAM KUMAR TT TRANS1S 1% CHANDIGARH 52479 Chandigarh’ TD 5. Natne Of Patient TATADEM 6-Relationship with Employee Spouse 7. Age 037 & Nature Of liness General 9. Name OF Doctor’Hoseltal Vaidya Karanvir Singh J CHANDIGARH AYURVED &PANCAKARMA CENTRE 10. Details. OF Claim = Date of Claim Stébmission Dac 14,2023 {attach prescription, vouchers) { Voucher Date Claim Type Woucher No’ ‘Amount \ \ Dec 6, 2023 Censiatin #r240N0 3088 509.00 i [bere 208 isa BORER ORB 72800 | TOTAL 3728.90 Declaration : | hereby declare tat the statements glven in.application are true to the best of my knowledge and bellef and thai the person for which mediéal expenses are incurred is wholly dependent on me_- ee (Signatule of Employee) Mobile No. gagasaagay