Max Hospital, Gurgaon
B - Block, Sushant Lok - I
Gurgaon - 122 001
Mobile No. : 9810332727
Bill of Supply *120580976*
:
Patient Name : Ms. Anika Bajpai Bill Date : 25/08/2023 03:50PM
Age/Sex : 32 Year(s) / Female MaxId / SSN : SHGN.580976 / 120580976
Address : NA Bill No / Receipt No : GNCS2704999 / GNRC2617804
GSTN Bill : AG23OD0000091132
Referred By : SELF GSTN No : 06AAACA6671N1ZE
Services Net Tax Amt
Sl.N SAC Qty Base Tariff Discounts Amount (R (Tax %) Bill
o. Price(Rs. Price(Rs.) Amount (R
)
Vishakha Bhalla (Consulta
1 99931200001 1 800.00 800.00 0.00 800.00 800.00
tion ) (GGN-PSYCHOLOG
Y)
Total : 0.00 800.00 0.00 800.00
Paid by Patient : 800.00
Amount in Words : Rupees eight hundred only collected from patient
Sum Of Rs. 800.00 received with thanks from Ms. Anika Bajpai
Payment Mode(s)
Online Payment for Rs.800.00(Transaction Id :17998171976, Booking Id : 5e1495b6-6bc7-4337-b79e-912ef807c3a2 ) Signature
Signature of Patient/Next of Kin OnlinePaymentUserGGN
(This is system generated document and does not require signature)
Place of Supply : Haryana-( 06) PAN No. : AAACA6671N
Company Name : Max Hospital(A Unit of Alps Hospital Limited)
