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Dr. LalPathLabs Ltd.

Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,


Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply

MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4


PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Invoice Print Date..........: 3/1/2020


SHOP NO-4 CHURCH ROAD OPP-
GURUDWARA GALI VIKAS NAGAR Invoice Period..: 24/02/2020..29/02/2020
DEHRADUN ,
VIKASNAGAR,
DEHRADUN248198
UTC ,IND

Dear Sir / Madam,


We are enclosing the bill pertaining to the tests undergone by employees/patients of your organization
for the period from 2/24/2020 to 2/29/2020
If any discrepancy/Adjustment/Deduction on account of TDS or any other deduction made at the time of
payment,Please attach a summary statement of deduction with the payment.
Kindly remit the total payable amount (18,203.50) at the earliest through NEFT/RTGS/ Fund transfer as
per details given below.
BENEFICIARY NAME : DR LAL PATHLABS LIMITED
BANK NAME : HDFC BANK LTD
BANK ACCOUNT NUMBER : DRLALP C004283062
BRANCH NAME : SANDOZ BRANCH, MUMBAI
IFSC CODE : HDFC0000240

Thanking you
Yours Truly
For Dr Lal PathLabs Ltd.

(Authorised Signatory.)
PAN NO – AAACD3377J
TAN NO – DELD03576G
Note :
1. This is a computer generated bill and does not require signature/stamp.
2. Please do not make payment in cash ,we shall not be responsible for loss in cash handling.
3. Please use below mentioned deposit slip to deposit Cheque/DD in our HDFC Bank
4. Please fill Cheque No.,Cheque Date, Drawee Bank and Amount in below deposit Slip.
5. Dr. Lal PathLabs Ltd. is exempt from GST being a healthcare service provider.

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi­110085 ,Phone: 91­11­39885050 , Fax; 91­11­3040­3204

CORPORATE PRODUCT & SERVICES Local Outstation Transfer

Company Name - DR LAL PATHLABS LIMITED Date


Deposit Slip No
Client Code LALPATHLAB Location

Sr No Drawer Name Drawer Code Cheque No Cheque Date Drawee Bank Drwan Location Amount
1 MR. SUNNY SAHNI - HEALTHCARE DIAGN C004283062
2
3
Total
Count Of Cheques

Depositor's Signature Teller Signaturey

Depositor Name & Contact Number


Dr. LalPathLabs Ltd. Page 1
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316
Date Name Lab No. Gross Price Revenue Share Discount Net Price
2/24/2020 SOHAN SINGH 281618034 10.00 0.00 0.00 10.00
2/24/2020 MAHENDER KAUR 281618035 10.00 0.00 0.00 10.00
2/24/2020 RAJESH AGGARWAL 281618036 199.00 20.00 0.00 179.00
2/24/2020 ANIL AGGARWAL 281618037 199.00 20.00 0.00 179.00
2/24/2020 SURJEET KAUR 281618038 10.00 0.00 0.00 10.00
2/24/2020 RAJESH 281618039 10.00 0.00 0.00 10.00
2/24/2020 NARENDER KAUR 281618040 20.00 0.00 0.00 20.00
2/24/2020 DLIP KAUR 281618041 10.00 0.00 0.00 10.00
2/24/2020 ROHIT SAINI 281618042 50.00 10.00 0.00 40.00
2/24/2020 KULDEEP KAUR 281618043 819.00 70.00 0.00 749.00
2/24/2020 MANI 281618044 1,360.00 340.00 0.00 1,020.00
2/24/2020 SAPNA 281618045 130.00 15.00 0.00 115.00
2/24/2020 REENA 281618046 130.00 15.00 0.00 115.00
2/24/2020 KULDEEP KAUR 281618047 120.00 30.00 0.00 90.00
2/24/2020 SANDEEP MONGA 281618048 1,280.00 320.00 0.00 960.00
2/24/2020 SANDEEP MONGA 281618049 10.00 0.00 0.00 10.00
2/24/2020 MANI 281618050 50.00 10.00 0.00 40.00
2/24/2020 BALA DEVI 281618051 70.00 17.50 0.00 52.50
2/24/2020 DLIP KAUR 281618052 120.00 30.00 0.00 90.00
2/24/2020 RATNI DEVI 281618053 2,899.00 0.00 999.00 1,900.00
2/24/2020 S.K. KARANWAL 281618054 1,580.00 395.00 0.00 1,185.00
2/24/2020 NILANJO 281618055 120.00 30.00 0.00 90.00
2/24/2020 TRUN GUPTA 281618056 930.00 232.50 0.00 697.50
2/24/2020 PRAVEEN 281618057 10.00 0.00 0.00 10.00
2/25/2020 BHAAVNA 281618058 70.00 10.00 0.00 60.00
2/25/2020 SANTOSH 281618059 20.00 0.00 0.00 20.00
2/25/2020 PRIYA KHURANA 281618060 20.00 0.00 0.00 20.00
2/25/2020 PRADEEP KHURANA 281618061 20.00 0.00 0.00 20.00
2/25/2020 JYOTI THAKUR 281618062 70.00 10.00 0.00 60.00
2/25/2020 SANDEEP 281618063 600.00 50.00 0.00 550.00
2/25/2020 AASHU 281618064 130.00 15.00 0.00 115.00
2/25/2020 VANDNA 281618065 920.00 230.00 0.00 690.00
2/25/2020 REKHA SHARMA 281618066 130.00 15.00 0.00 115.00
2/25/2020 MANISH TANDAN 281618067 100.00 25.00 0.00 75.00
2/26/2020 SAVITA MITTAL 281618068 60.00 10.00 0.00 50.00
2/26/2020 SATENDER LALA 281618069 30.00 0.00 0.00 30.00
2/26/2020 RAJEEV CHUGH 281618070 209.00 49.00 0.00 160.00
2/26/2020 BHUMI CHAND 281618071 1,640.00 310.00 0.00 1,330.00
2/26/2020 URVASHI WALIA 281618072 1,600.00 350.00 0.00 1,250.00
2/27/2020 BHUMI CHAND 281618073 280.00 0.00 280.00 0.00
2/27/2020 SANTOSH 281618074 1,299.00 0.00 499.00 800.00
2/27/2020 GEETA KASHYAP 281618075 420.00 97.50 0.00 322.50
2/27/2020 ANITA DOBHAL 281618082 130.00 15.00 0.00 115.00
2/28/2020 DEEPAK 281618076 20.00 0.00 0.00 20.00
2/28/2020 UPSESH 281618077 199.00 49.00 0.00 150.00
2/28/2020 VIKRAM CHANDEL 281618079 50.00 10.00 0.00 40.00
2/28/2020 PRIYA KHURANA 281618080 10.00 0.00 0.00 10.00
2/28/2020 PRADEEP KHURANA 281618081 10.00 0.00 0.00 10.00
2/28/2020 SABINA MAZ 281618083 580.00 127.50 0.00 452.50
2/28/2020 R.S TIWARI 281618084 1,699.00 0.00 599.00 1,100.00
2/28/2020 R.S TIWARI 281618085 20.00 0.00 0.00 20.00
2/28/2020 KAILSAHI DEVI 281618086 20.00 0.00 0.00 20.00
2/28/2020 ANKUSH 281618087 660.00 165.00 0.00 495.00
2/28/2020 PINKI SURI 281618088 630.00 157.50 0.00 472.50
2/28/2020 SAIMA 281618089 130.00 15.00 0.00 115.00
2/28/2020 MEERA DEVI 281618090 100.00 25.00 0.00 75.00
2/28/2020 VIPIN SINGH 281618091 1,960.00 490.00 0.00 1,470.00
23982.00 3780.50 2377.00 17824.50

Gross Amount ...............................................: 23982.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 2
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316
Discount Amount ...........................................: 2377.00
Revenue Share .............................................: 3780.50
TDS(@ 10 % )................................................: 379.00
Total Payable Amount ...................................: 18203.50

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 3
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Name: KULDEEP KAUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 B024 URIC ACID, SERUM 281618047 120.00 30.00 0.00 90.00
Total For Patient : KULDEEP KAUR 120.00 30.00 0.00 90.00

Name: RAJESH AGGARWAL

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP14 BTL -HBA1C 281618036 199.00 20.00 0.00 179.00


2/24/2020 B080 HEMOGLOBIN A1 281618036 0.00 0.00 0.00 0.00
(C)/HGBA1C/GLYCAT
Total For Patient : RAJESH AGGARWAL 199.00 20.00 0.00 179.00

Name: S.K. KARANWAL

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 Z007 KIDNEY FUNCTION TEST/ 281618054 650.00 162.50 0.00 487.50
2/24/2020 Z021 RENAL FU BLOOD
COMPLETE 281618054 280.00 70.00 0.00 210.00
2/24/2020 Z005 COUNT;CBC
LIVER PANEL 1; LFT 281618054 650.00 162.50 0.00 487.50
Total For Patient : S.K. KARANWAL 1580.00 395.00 0.00 1185.00

Name: MAHENDER KAUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP02 CHOLESTEROLTOTAL 281618035 10.00 0.00 0.00 10.00


Total For Patient : MAHENDER KAUR 10.00 0.00 0.00 10.00

Name: SANDEEP MONGA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 Z021 COMPLETE BLOOD 281618048 280.00 70.00 0.00 210.00


2/24/2020 Z005 COUNT;CBC
LIVER PANEL 1; LFT 281618048 650.00 162.50 0.00 487.50
2/24/2020 H131 PROTHROMBIN TIME 281618048 350.00 87.50 0.00 262.50
Total For Patient : SANDEEP STUDIES
MONGA 1280.00 320.00 0.00 960.00

Name: MANI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 H023 DLC (DIFFERENTIAL 281618044 80.00 20.00 0.00 60.00


2/24/2020 B023 LEUCOCYTE CO
CREATININESERUM 281618044 100.00 25.00 0.00 75.00
2/24/2020 H003 TLC 281618044 80.00 20.00 0.00 60.00
2/24/2020 D031 (TOTALLEUCOCYTECOUNT)
VALPROICACIDVALPROAT 281618044 800.00 200.00 0.00 600.00
2/24/2020 B069 LITHIUM 281618044 300.00 75.00 0.00 225.00
2/24/2020 WJP05 TSH (THYROID 281618050 50.00 10.00 0.00 40.00
Total For Patient : MANI STIMULATING HORMO 1410.00 350.00 0.00 1060.00

Name: SAPNA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 Z284 THYROIDPROFILETOTAL( 281618045 130.00 15.00 0.00 115.00


Total For Patient : SAPNA 130.00 15.00 0.00 115.00

Name: REENA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 Z284 THYROIDPROFILETOTAL( 281618046 130.00 15.00 0.00 115.00


Total For Patient : REENA 130.00 15.00 0.00 115.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 4
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Name: BALA DEVI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 B001 GLUCOSEFASTING(F) 281618051 70.00 17.50 0.00 52.50


Total For Patient : BALA DEVI 70.00 17.50 0.00 52.50

Name: DLIP KAUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 B024 URIC ACID, SERUM 281618052 120.00 30.00 0.00 90.00
2/24/2020 WJP04 BTLJOGGERPARKFASTING 281618041 10.00 0.00 0.00 10.00
Total For Patient : DLIP KAUR 130.00 30.00 0.00 100.00

Name: RATNI DEVI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WM17 SWASTH SUPER 4 281618053 2899.00 0.00 999.00 1900.00


2/24/2020 Z318 LIPID SCREEN, SERUM 281618053 0.00 0.00 0.00 0.00
2/24/2020 Z025 LIVER&KIDNEYPANEL*LF 281618053 0.00 0.00 0.00 0.00
2/24/2020 Z284 THYROIDPROFILETOTAL( 281618053 0.00 0.00 0.00 0.00
2/24/2020 R047 VITAMINB12CYANOCOBAL 281618053 0.00 0.00 0.00 0.00
2/24/2020 B080 HEMOGLOBIN A1 281618053 0.00 0.00 0.00 0.00
2/24/2020 Z021 (C)/HGBA1C/GLYCAT
COMPLETE BLOOD 281618053 0.00 0.00 0.00 0.00
2/24/2020 R119 COUNT;CBC
VITAMIND25HYDROXY 281618053 0.00 0.00 0.00 0.00
Total For Patient : RATNI DEVI 2899.00 0.00 999.00 1900.00

Name: NILANJO

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 B024 URIC ACID, SERUM 281618055 120.00 30.00 0.00 90.00
Total For Patient : NILANJO 120.00 30.00 0.00 90.00

Name: TRUN GUPTA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 Z021 COMPLETE BLOOD 281618056 280.00 70.00 0.00 210.00


2/24/2020 Z005 COUNT;CBC
LIVER PANEL 1; LFT 281618056 650.00 162.50 0.00 487.50
Total For Patient : TRUN GUPTA 930.00 232.50 0.00 697.50

Name: SOHAN SINGH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP02 CHOLESTEROLTOTAL 281618034 10.00 0.00 0.00 10.00


Total For Patient : SOHAN SINGH 10.00 0.00 0.00 10.00

Name: ANIL AGGARWAL

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP14 BTL -HBA1C 281618037 199.00 20.00 0.00 179.00


2/24/2020 B080 HEMOGLOBIN A1 281618037 0.00 0.00 0.00 0.00
(C)/HGBA1C/GLYCAT
Total For Patient : ANIL AGGARWAL 199.00 20.00 0.00 179.00

Name: SURJEET KAUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP04 BTLJOGGERPARKFASTING 281618038 10.00 0.00 0.00 10.00


Total For Patient : SURJEET KAUR 10.00 0.00 0.00 10.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 5
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Name: RAJESH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP04 BTLJOGGERPARKFASTING 281618039 10.00 0.00 0.00 10.00


Total For Patient : RAJESH 10.00 0.00 0.00 10.00

Name: NARENDER KAUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP10 HEMOGLOBIN; HB 281618040 10.00 0.00 0.00 10.00


2/24/2020 H001 HEMOGLOBINHb 281618040 0.00 0.00 0.00 0.00
2/24/2020 WJP04 BTLJOGGERPARKFASTING 281618040 10.00 0.00 0.00 10.00
Total For Patient : NARENDER KAUR 20.00 0.00 0.00 20.00

Name: ROHIT SAINI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP05 TSH (THYROID 281618042 50.00 10.00 0.00 40.00


STIMULATING HORMO
Total For Patient : ROHIT SAINI 50.00 10.00 0.00 40.00

Name: KULDEEP KAUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP14 BTL -HBA1C 281618043 199.00 20.00 0.00 179.00


2/24/2020 B080 HEMOGLOBIN A1 281618043 0.00 0.00 0.00 0.00
2/24/2020 WJP03 (C)/HGBA1C/GLYCAT
BTLJOGGERPARKPOSTPRA 281618043 10.00 0.00 0.00 10.00
2/24/2020 WJP09 NDIAL
VITAMIN D 25 - HYDROXY 281618043 600.00 50.00 0.00 550.00
2/24/2020 R119 VITAMIND25HYDROXY 281618043 0.00 0.00 0.00 0.00
2/24/2020 WJP04 BTLJOGGERPARKFASTING 281618043 10.00 0.00 0.00 10.00
Total For Patient : KULDEEP KAUR 819.00 70.00 0.00 749.00

Name: SANDEEP MONGA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP04 BTLJOGGERPARKFASTING 281618049 10.00 0.00 0.00 10.00


Total For Patient : SANDEEP MONGA 10.00 0.00 0.00 10.00

Name: PRAVEEN

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/24/2020 WJP03 BTLJOGGERPARKPOSTPRA 281618057 10.00 0.00 0.00 10.00


Total For Patient : PRAVEENNDIAL 10.00 0.00 0.00 10.00

Name: BHAAVNA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 WJP04 BTLJOGGERPARKFASTING 281618058 10.00 0.00 0.00 10.00


2/25/2020 WJP05 TSH (THYROID 281618058 50.00 10.00 0.00 40.00
2/25/2020 WJP10 STIMULATING
HEMOGLOBIN;HORMO
HB 281618058 10.00 0.00 0.00 10.00
2/25/2020 H001 HEMOGLOBINHb 281618058 0.00 0.00 0.00 0.00
Total For Patient : BHAAVNA 70.00 10.00 0.00 60.00

Name: SANTOSH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 WJP04 BTLJOGGERPARKFASTING 281618059 10.00 0.00 0.00 10.00


2/25/2020 WJP03 BTLJOGGERPARKPOSTPRA 281618059 10.00 0.00 0.00 10.00
Total For Patient : SANTOSHNDIAL 20.00 0.00 0.00 20.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 6
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Name: PRIYA KHURANA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 WJP04 BTLJOGGERPARKFASTING 281618060 10.00 0.00 0.00 10.00


2/25/2020 WJP10 HEMOGLOBIN; HB 281618060 10.00 0.00 0.00 10.00
2/25/2020 H001 HEMOGLOBINHb 281618060 0.00 0.00 0.00 0.00
Total For Patient : PRIYA KHURANA 20.00 0.00 0.00 20.00

Name: PRADEEP KHURANA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 WJP10 HEMOGLOBIN; HB 281618061 10.00 0.00 0.00 10.00


2/25/2020 H001 HEMOGLOBINHb 281618061 0.00 0.00 0.00 0.00
2/25/2020 WJP04 BTLJOGGERPARKFASTING 281618061 10.00 0.00 0.00 10.00
Total For Patient : PRADEEP KHURANA 20.00 0.00 0.00 20.00

Name: JYOTI THAKUR

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 WJP05 TSH (THYROID 281618062 50.00 10.00 0.00 40.00


2/25/2020 WJP10 STIMULATING
HEMOGLOBIN;HORMO
HB 281618062 10.00 0.00 0.00 10.00
2/25/2020 H001 HEMOGLOBINHb 281618062 0.00 0.00 0.00 0.00
2/25/2020 WJP03 BTLJOGGERPARKPOSTPRA 281618062 10.00 0.00 0.00 10.00
NDIAL
Total For Patient : JYOTI THAKUR 70.00 10.00 0.00 60.00

Name: SANDEEP

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 WJP09 VITAMIN D 25 - HYDROXY 281618063 600.00 50.00 0.00 550.00


2/25/2020 R119 VITAMIND25HYDROXY 281618063 0.00 0.00 0.00 0.00
Total For Patient : SANDEEP 600.00 50.00 0.00 550.00

Name: AASHU

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 Z284 THYROIDPROFILETOTAL( 281618064 130.00 15.00 0.00 115.00


Total For Patient : AASHU 130.00 15.00 0.00 115.00

Name: VANDNA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 H022 ABSOLUTEEOSINOPHILCO 281618065 120.00 30.00 0.00 90.00


2/25/2020 M011 CULTUREAEROBICSPUTUM 281618065 800.00 200.00 0.00 600.00
Total For Patient : VANDNA 920.00 230.00 0.00 690.00

Name: REKHA SHARMA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 Z284 THYROIDPROFILETOTAL( 281618066 130.00 15.00 0.00 115.00


Total For Patient : REKHA SHARMA 130.00 15.00 0.00 115.00

Name: MANISH TANDAN

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/25/2020 U001 URINEEXAMINATIONROUT 281618067 100.00 25.00 0.00 75.00


Total For Patient : MANISH TANDAN 100.00 25.00 0.00 75.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 7
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Name: BHUMI CHAND

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/26/2020 B023 CREATININESERUM 281618071 100.00 25.00 0.00 75.00


2/26/2020 B033 SGPT 281618071 120.00 30.00 0.00 90.00
2/26/2020 B072 RF SERUM 281618071 420.00 105.00 0.00 315.00
2/26/2020 Z021 COMPLETE BLOOD 281618071 280.00 70.00 0.00 210.00
2/26/2020 B149 COUNT;CBC
ANTI CITRULLINATED 281618071 600.00 50.00 0.00 550.00
2/26/2020 B032 ANTIBODY/AN
SGOT 281618071 120.00 30.00 0.00 90.00
Total For Patient : BHUMI CHAND 1640.00 310.00 0.00 1330.00

Name: URVASHI WALIA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/26/2020 Z007 KIDNEY FUNCTION TEST/ 281618072 650.00 162.50 0.00 487.50
2/26/2020 F007 RENAL FU
CARBOHYDRATE ANTIGEN 281618072 600.00 100.00 0.00 500.00
2/26/2020 Z367 125
LIVERPANELSCREEN 281618072 350.00 87.50 0.00 262.50
Total For Patient : URVASHI WALIA 1600.00 350.00 0.00 1250.00

Name: RAJEEV CHUGH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/26/2020 WJP04 BTLJOGGERPARKFASTING 281618070 10.00 0.00 0.00 10.00


2/26/2020 WJP07 LIPID PROFILE, SCREEN 281618070 199.00 49.00 0.00 150.00
2/26/2020 Z318 LIPID SCREEN, SERUM 281618070 0.00 0.00 0.00 0.00
Total For Patient : RAJEEV CHUGH 209.00 49.00 0.00 160.00

Name: SAVITA MITTAL

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/26/2020 WJP05 TSH (THYROID 281618068 50.00 10.00 0.00 40.00


2/26/2020 WJP04 STIMULATING HORMO
BTLJOGGERPARKFASTING 281618068 10.00 0.00 0.00 10.00
Total For Patient : SAVITA MITTAL 60.00 10.00 0.00 50.00

Name: SATENDER LALA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/26/2020 WJP02 CHOLESTEROLTOTAL 281618069 10.00 0.00 0.00 10.00


2/26/2020 WJP04 BTLJOGGERPARKFASTING 281618069 10.00 0.00 0.00 10.00
2/26/2020 WJP10 HEMOGLOBIN; HB 281618069 10.00 0.00 0.00 10.00
2/26/2020 H001 HEMOGLOBINHb 281618069 0.00 0.00 0.00 0.00
Total For Patient : SATENDER LALA 30.00 0.00 0.00 30.00

Name: BHUMI CHAND

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/27/2020 Z021 COMPLETE BLOOD COUNT; 281618073 280.00 0.00 280.00 0.00
CBC
Total For Patient : BHUMI CHAND 280.00 0.00 280.00 0.00

Name: SANTOSH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/27/2020 WM14 SWASTH SUPER 1 281618074 1299.00 0.00 499.00 800.00


2/27/2020 Z318 LIPID SCREEN, SERUM 281618074 0.00 0.00 0.00 0.00
2/27/2020 Z025 LIVER&KIDNEYPANEL*LF 281618074 0.00 0.00 0.00 0.00
2/27/2020 Z284 THYROIDPROFILETOTAL( 281618074 0.00 0.00 0.00 0.00
Total For Patient : SANTOSH 1299.00 0.00 499.00 800.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 8
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316

Name: GEETA KASHYAP

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/27/2020 Z021 COMPLETE BLOOD 281618075 280.00 70.00 0.00 210.00


2/27/2020 B001 COUNT;CBC
GLUCOSEFASTING(F) 281618075 70.00 17.50 0.00 52.50
2/27/2020 R052 TSHTOTAL 281618075 70.00 10.00 0.00 60.00
Total For Patient : GEETA KASHYAP 420.00 97.50 0.00 322.50

Name: ANITA DOBHAL

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/27/2020 Z284 THYROIDPROFILETOTAL( 281618082 130.00 15.00 0.00 115.00


Total For Patient : ANITA DOBHAL 130.00 15.00 0.00 115.00

Name: VIPIN SINGH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 B045 POTASSIUMSERUM 281618091 130.00 32.50 0.00 97.50


2/28/2020 B044 SODIUMSERUM 281618091 130.00 32.50 0.00 97.50
2/28/2020 B023 CREATININESERUM 281618091 100.00 25.00 0.00 75.00
2/28/2020 R049 ALDOSTERONESERUM 281618091 1600.00 400.00 0.00 1200.00
Total For Patient : VIPIN SINGH 1960.00 490.00 0.00 1470.00

Name: PRIYA KHURANA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP02 CHOLESTEROLTOTAL 281618080 10.00 0.00 0.00 10.00


Total For Patient : PRIYA KHURANA 10.00 0.00 0.00 10.00

Name: PRADEEP KHURANA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP02 CHOLESTEROLTOTAL 281618081 10.00 0.00 0.00 10.00


Total For Patient : PRADEEP KHURANA 10.00 0.00 0.00 10.00

Name: DEEPAK

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP02 CHOLESTEROLTOTAL 281618076 10.00 0.00 0.00 10.00


2/28/2020 WJP03 BTLJOGGERPARKPOSTPRA 281618076 10.00 0.00 0.00 10.00
Total For Patient : DEEPAK NDIAL 20.00 0.00 0.00 20.00

Name: UPSESH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP07 LIPID PROFILE, SCREEN 281618077 199.00 49.00 0.00 150.00
2/28/2020 Z318 LIPID SCREEN, SERUM 281618077 0.00 0.00 0.00 0.00
Total For Patient : UPSESH 199.00 49.00 0.00 150.00

Name: VIKRAM CHANDEL

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP05 TSH (THYROID 281618079 50.00 10.00 0.00 40.00


STIMULATING HORMO
Total For Patient : VIKRAM CHANDEL 50.00 10.00 0.00 40.00

Name: SABINA MAZ

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 Z284 THYROIDPROFILETOTAL( 281618083 130.00 15.00 0.00 115.00


2/28/2020 Z390 FEVERPANEL1*Hemogram 281618083 450.00 112.50 0.00 337.50

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 9
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316
2/28/2020 Z021 COMPLETE BLOOD 281618083 0.00 0.00 0.00 0.00
2/28/2020 H009 COUNT;CBC
ESR 281618083 0.00 0.00 0.00 0.00
2/28/2020 H030 (WESTERGREN)ERYTHROC
MALARIAPARASITEBLOOD 281618083 0.00 0.00 0.00 0.00
2/28/2020 S026 WIDALSLIDEAGGLUTINAT 281618083 0.00 0.00 0.00 0.00
2/28/2020 U001 URINEEXAMINATIONROUT 281618083 0.00 0.00 0.00 0.00
Total For Patient : SABINA MAZ 580.00 127.50 0.00 452.50

Name: R.S TIWARI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WM15 SWASTH SUPER 2 281618084 1699.00 0.00 599.00 1100.00


2/28/2020 Z318 LIPID SCREEN, SERUM 281618084 0.00 0.00 0.00 0.00
2/28/2020 Z025 LIVER&KIDNEYPANEL*LF 281618084 0.00 0.00 0.00 0.00
2/28/2020 Z284 THYROIDPROFILETOTAL( 281618084 0.00 0.00 0.00 0.00
2/28/2020 B080 HEMOGLOBIN A1 281618084 0.00 0.00 0.00 0.00
2/28/2020 Z021 (C)/HGBA1C/GLYCAT
COMPLETE BLOOD 281618084 0.00 0.00 0.00 0.00
COUNT;CBC
Total For Patient : R.S TIWARI 1699.00 0.00 599.00 1100.00

Name: ANKUSH

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 B033 SGPT 281618087 120.00 30.00 0.00 90.00


2/28/2020 Z019 HEMOGRAM *CBC * ESR 281618087 320.00 80.00 0.00 240.00
2/28/2020 B023 CREATININESERUM 281618087 100.00 25.00 0.00 75.00
2/28/2020 B032 SGOT 281618087 120.00 30.00 0.00 90.00
Total For Patient : ANKUSH 660.00 165.00 0.00 495.00

Name: PINKI SURI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 Z367 LIVERPANELSCREEN 281618088 350.00 87.50 0.00 262.50


2/28/2020 Z021 COMPLETE BLOOD 281618088 280.00 70.00 0.00 210.00
COUNT;CBC
Total For Patient : PINKI SURI 630.00 157.50 0.00 472.50

Name: SAIMA

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 Z284 THYROIDPROFILETOTAL( 281618089 130.00 15.00 0.00 115.00


Total For Patient : SAIMA 130.00 15.00 0.00 115.00

Name: MEERA DEVI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 U001 URINEEXAMINATIONROUT 281618090 100.00 25.00 0.00 75.00


Total For Patient : MEERA DEVI 100.00 25.00 0.00 75.00

Name: R.S TIWARI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP04 BTLJOGGERPARKFASTING 281618085 10.00 0.00 0.00 10.00


2/28/2020 WJP03 BTLJOGGERPARKPOSTPRA 281618085 10.00 0.00 0.00 10.00
NDIAL
Total For Patient : R.S TIWARI 20.00 0.00 0.00 20.00

Name: KAILSAHI DEVI

Date Test Code Test Name Lab No. Gross Amt. Revenue Share Discount Line Amount

2/28/2020 WJP04 BTLJOGGERPARKFASTING 281618086 10.00 0.00 0.00 10.00

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204
Dr. LalPathLabs Ltd. Page 10
Corporate Office: 12th Floor, Tower–B, SAS Tower, Medicity, Sector-38,
Gurgaon-122001, Phone:0124-301-6500 , Fax: 0124-423-4468
CIN No: L74899DL1995PLC065388
Bill Of Supply
Invoice Print Date.................: 3/1/2020
MR. SUNNY SAHNI - HEALTHCARE DIAGNOSTICS CC Summary Of Invoice No..: C004283062/19-20/Feb/4
PAN Number..................: BYVPS6934B
SAC No...........................: 999316
2/28/2020 WJP03 BTLJOGGERPARKPOSTPRA 281618086 10.00 0.00 0.00 10.00
Total For Patient : KAILSAHI NDIAL
DEVI 20.00 0.00 0.00 20.00

Total Payable (Rs) : 17824.50

Gross Amount ...............................................: 23982.00


Discount Amount ...........................................: 2377.00
Revenue Share .............................................: 3780.50
TDS(@ 10 % )................................................: 379.00
Total Payable Amount ...................................: 18203.50

Regd. Office:Dr. Lal PathLabs Ltd., Block E, Sector 18, Rohini, New Delhi-110085 ,Phone: 91-11-39885050 , Fax; 91-11-3040-3204