SANOFI pakistan ltd

MEDICAL BILL FORM

Name of
M.Azam Date 10/18/2017
Employee Mr.

Personal No 3038 Designation ___ FE Cost Centre 75125

Sale
Job Title Department ___ Sale Location Faisalabad

Name of Patient & Name of Attending Cost of Other

Professional Fee Total Amount
Relationship DOCTOR Medicine Charges
Self Dr M.Yousaf 1000 6900 7900
Self Muhammad Shafique 500 5118 5618

Rayyan Muhammad Naeem 1000 1589 2589

Ahmad(Son) Khan
Mrs Azan(Wife) Muhammad Yousaf 1000 6616 7616
Mrs Azan(Wife) Muhammad Shafique 500 2935 3435

Total 27158
Less 10%
PAYABLE

Signature of Employee

FOR OFFICIAL USE

Basic Salary Rs.

Medical Bills paid upto last Month Rs.
Balance Available Rs.
Present Bill Rs.
Balance / Exceess Rs. Approved By: ___________
__
 SANOFI pakistan ltd
MEDICAL BILL FORM
Name of
Date
Employee Mr.

Personal No Designation ___ Cost Centre

Job Title Department ___ Location

Name of Patient & Name of Attending Cost of Other

Professional Fee Total Amount
Relationship DOCTOR Medicine Charges

Total

Less 10%

PAYABLE

Signature of Employee

FOR OFFICIAL USE

Basic Salary Rs.

Medical Bills paid upto last Month Rs.
Balance Available Rs.
Present Bill Rs.
Balance / Exceess Rs. Approved By: ___________
__