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 Hospital Receipts Online Challan
 Receipt Details     
1 Hopital Receipts *
MemberID *  
3 Head Code Others Description
4 Amount * * Payment Mode
5 Ref.No. Remarks1
6 Remitted By * *   Remarks2 *  
7 DD No   DD Amount
8 DD Bank Name   DD Date(dd-mon-yyyy)
  Select Bank :    
 
 Union Bank Of India    
 
  Indian Bank    
 
Pharmacy Receipts