PRISTINE DENTAL CENTRE @ EMPIRE Tax Invoice

Tax Invoice No.: REP-A014050/2023

F-38, 1st Floor, Empire Shopping Gallery,
GST No. : Company Tax Code
Jalan SS 16/1, Subang Jaya, 47500 Selangor Darul Ehsan.
Invoice Date: 21-05-2023
Tel: 6-03-5612 5632 Email: empire@pristinedental.com.mY

Received from SARAH AMANI BINTI ALI AL-AMANI

the sum of Ringgit Malaysia **** 180.00 **** _
. · --· --··-··· ··· --·· ·· -··
being payment for treatment/ medication as per following description

No Description - --- - ~ Ta~(%) ~ x Amt. J Unit Price (RM)I Discount! Total Price (RM);
1 •Consultation & Examination - 1 0% 0.00 80-. 0L-------=
0.:.. .O
oc-:=o+-- - -,.; ~0
80~.0

Fluoride Treatment I Varnish 0% 0.00 100.00 0-:-00· 100.ocf

2

Discount (-) : 0.00

Remark: Subtotal: 180.00

GST (+) : 0.00

Rounding: 0.00

BIiiing Type: - Cash Patient - Total: 180.00

Payment Record
No Payment ID Date Amount (RM) Payment Method Remark Collected By
1 16068 21-05-2023 180.00 MASTER empire
Accumulated Payment: 180.00

Overdue Balance : 0.00

PRISTINE DENTAL EM
F-38, First Floor, Empire Sho E SO~ - HD
Payment Collected By :_____ _ JaJan..ssim. PP,:c~ ailerx_
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Tel: 03-5612 5632 an