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47301 Kelana Jaya, Selangor Darul Ehsan
MediExpress (Malaysia) Sdn Bhd
& £67, Bock F, Patan Commer ub, No.2! Jalan 85725
Mediexpress
Tel No: 03-7884 1818 Fax No: 03-7809 9222
Payment Voucher - ia : a
Payee RAJA SITIAISYAH BINTI RAJA AZML Voucher No: CB00156813
Address Cheque No : ON16022024
Date 15/02/24,
Att Accounts Department
PARTICULARS _ 7 7 =H sss RM
| No. Invoice no. Inv. Date Case no.: Bordx. No. Receipt No iz
| 4 Pai 05/02/2024 | TAQ0056399___ DTAQG025 _ 40.00
___Being Payment for Medical Report paid to the above :- PEE |
__Patient Name : Rogayah Binti Abdullah -
D.O.A.: 12/12/2023 H - Ht -
NRIC : 770322-03-6390_ ot eeu 4
(azwin) = a _ 4
TOTAL 40.00
Prepared by: LISA Peete ‘Acknowledgement of receipt:
Approved by: - —_____—.
Signatories : ssa
‘Signature & Company Stamp -
@ Maybank
Applicant Details
Appi
Debiting Account No.
Bank
Beneficiary Details
8
iciary
Beneficiary Account No.
Bank
Transaction Details
Amour
value ate
Reference Neo.
Debit Description
Maybank2e Debit Advice
MEDIEXPRESS (M) SDN. BHO.
5tze91132293,
maybank
RAJA SITIAISYAH BINTI RASA AZM
se3104229051
Mayoan®
Myr 40.009
46 Feb 2024 MY (UTC-+02:003
myir2a0218734402,
1A00056339.3
Note : This receipt is computer generated and no signature is required.
