[Hospital Name]

[HospitalAddress]

DEPOSIT REFUND RECEIPT
[PatientName] Patient No : [Patient Id]
[Age] Refund No : [Refund No]
[Address] Refund Date : [Refund Date]
[contactno] Deposit No : [Advance No]
Payment Type : [Payment Type]

Amount in Rupees
[item List]
Recieved With thanks from :[PatientName]

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