Max Super Speciality Hospital Vaishali
W-3 Sector-1, Vaishali, Ghaziabad, NCR,
Uttar Pradesh – 201012
Mobile No. : 9876919183
Bill of Supply
:
Patient Name : Mr. Aditya Kumar Bill Date : 20/05/2023 11:45AM
Age/Sex : 23 Year(s) / Male MaxId : VSLI.499163
Address : NA Bill No / Receipt No : VACS2460702 / VARC2390906
GSTN Bill : CR23OD0000061955
Referred By : SELF GSTN No : 09AACCC4239Q1Z6
Services Net Tax Amt
Sl.N SAC Qty Base Tariff Discounts Amount (R (Tax %) Bill
o. Price(Rs. Price(Rs.) Amount (R
)
Vimal Dassi (Consultation
1 99931200001 1 1,200.00 1,080.00 0.00 1,080.00 1,080.00
)( Urologist) ()
Total : 0.00 1,080.00 0.00 1,080.00
Paid by Patient : 1080.00
Amount in Words : Rupees one thousand eighty only collected from patient
Sum Of Rs. 1,080.00 received with thanks from Mr. Aditya Kumar
Payment Mode(s)
Online Payment for Rs.1080.00(Transaction Id :17390256528, Booking Id : aeaa3c7c-778c-403d-8d83-ce9c1b473548 ) Signature
Signature of Patient/Next of Kin OnlinePaymentUserVSH
(This is system generated document and does not require signature)
Place of Supply : Uttar Pradesh-( 09) PAN No. : AACCC4239Q
Company Name : Max Super Speciality Hospital-Vaishali (A unit of Crosslay Remedies Ltd.)
