Tax Invoice Invoice Number: C049-19-00605132

Original for Receipt

Keep the original invoice and barcode on medicines intact for returns

Sold By Bill To / Ship To (Patient)

M/S Laxmi Chemist Order Id: 16633887
Manjura Khatun
670 Uttar Panchanna Gram, Paschmi Chowbhaga, Order Date: 2020-03-02 Vill. Barati ,P.O. Baidyapur Shibtala,
First Floor, VIP Nagar, Tiljala, Kolkata
Dist. :Burdwan, , Tarkeshwar, West
Invoice Date: 2020-03-04 Bengal, 712410
DL Number WB/KOL/NBO/R/277130(2024-10-24),
Doctor Name Dr. Shahnawaz,
WB/KOL/BIO/R/277130(2024-10-24),

GSTIN 19AAHFL1873B1ZE POS : 19-West Bengal

S No Description of Goods MFR/MKT HSN Batch No Exp MRP Discount Unit Price GST % Qty Amount

1 BONEO TABLET 10'S BLI 3004 1914005 05/21 229.00 45.80 183.20 12.00 3 687

S1981716K
2 FLUGESIC P TAB LUP 30049069 10/21 131.55 26.31 105.24 12.00 2 263.1

PANTAKIND DSR 40MG

3 MAN 30049039 F6AGS034 05/21 80.50 16.10 64.40 12.00 3 241.5
CAPSULE 10'S
TOR19E030
4 PREGABA 75MG CAP UNI 30049081 04/21 154.41 30.88 123.53 12.00 1 154.41

S1981718K
5 FLUGESIC P TAB LUP 30049069 10/21 131.55 26.31 105.24 12.00 1 131.55

TOR19H056
6 PREGABA 75MG CAP UNI 30049081 07/21 154.41 30.88 123.53 12.00 3 463.23

Taxable Value SGST % SGST Amt. CGST % CGST Amt.

Notes:
1386.29 6.0 83.18 6.0 83.18
0.0 9.0 0 9.0 0
Total 1386.29 0.0 83.18 0.0 83.18

For M/S Laxmi Chemist MRP Total 1,940.79

Name of the PharmEasy Savings @ 20.0% -388.15

Pharmacist Debabrata
Subtotal 1552.64

PR Number Rounding Off 0.36

A-15126

Pharmacist Signature

(Rounded Off)
Note: Total savings Rs. 388.00 Total Invoice Amount Rs. 1,553

Amount In Words : One thousand Five Hundred Fifty Three Rupees only.
*Charges inclusive of GST (HSN - 9997)
Customer Acknowledgement: I,Manjura Khatun hereby recognise and accept the delivery of my order in full as prescribed by my doctor. I
acknowledge that the ordered medicines are for my own consumption and will not be used to sell to any third party until specified for.
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