File No:

Date: //

From:

To,

Subject:

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FMR Code :

ITEM DETAILS & PRICE:

Item Name	Quantity	Rate(Exclussive of GST)	GST(%)	Total Amount(Incl. GST)	Delivery Destinations
COMMUNITY FOLLOW UP CARD ( )	46070	1.520	18	82,631.15	As per annexure A
Admission Sheets ( )	42210	1.520	18	75,707.86	As per annexure A
Discharge Card ( )	45780	1.520	18	82,111.01	As per annexure A
File Folder ( )	64365	5.600	18	425,323.92	As per annexure A
Facility follow up record book ( )	330	220.000	18	85,668.00	As per annexure A
Referral summary book ( )	60	66.000	18	4,672.80	As per annexure A
Discharge note for SCNU record book ( )	475	78.000	18	43,719.00	As per annexure A
Investigation Book ( )	455	39.000	18	20,939.10	As per annexure A
TREATMENT CONTINUATION ( )	1090	39.000	18	50,161.80	As per annexure A
Clinical condition Record sheet ( )	1040	39.000	18	47,860.80	As per annexure A
Monitoring sheet ( )	1690	39.000	18	77,773.80	As per annexure A
Nurses order sheet ( )	1715	39.000	18	78,924.30	As per annexure A
Grand Total				1,075,493.54

Annexure A:

Sl	Item Name	Specification	Rate(Exclussive of GST)	GST(%)	Total quantity to be supplied	Total Amount	Delivery Destinations
1	COMMUNITY FOLLOW UP CARD		1.520	18	46070	82631.152
2	Admission Sheets		1.520	18	42210	75707.856
3	Discharge Card		1.520	18	45780	82111.008
4	File Folder		5.600	18	64365	425323.92
5	Facility follow up record book		220.000	18	330	85668
6	Referral summary book		66.000	18	60	4672.8
7	Discharge note for SCNU record book		78.000	18	475	43719
8	Investigation Book		39.000	18	455	20939.1
9	TREATMENT CONTINUATION		39.000	18	1090	50161.8
10	Clinical condition Record sheet		39.000	18	1040	47860.8
11	Monitoring sheet		39.000	18	1690	77773.8
12	Nurses order sheet		39.000	18	1715	78924.3

Memo No:

Date: //

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