[Hospital Name]

[HospitalAddress]

DEPOSIT RECEIPT [Cancelled]
Name : [PatientName] Patient No : [Patient Id]
Age/Sex : [Age] Deposit No : [Advance No]
Address : [Address] Payment Type : [Ptype]
Contact No : [contactno] Deposit Date : [Advance Date]
[item List]
Recieved With thanks from :[PatientName]

Remarks :[Remarks]

In Words :[rupees]
Total Amount : [Total]
Cashier
Counter :[counter] User :[user]