Invoice Chemist in Belgium Brussels –Free Word Template Download with AI
Chemist & Pharmacy Services
12, Rue du Sablon
1000 Brussels, Belgium
Tel: +32 2 511 45 67
Email: [email protected]
VAT No. (BTW): BE 0456.789.123
IBAN: BE 68 5390 0754 7034
BCE / RLE: Brussels
Facture / Factuur
Invoice No: INV-2025-00847
Date: 15 June 2025
Due Date: 15 July 2025
| Ref | Description of Goods / Services | Quantity | Unit Price (EUR) | VAT Rate | Amount (EUR) |
|---|---|---|---|---|---|
| 01 | Amoxicillin 500 mg capsules (28 tablets) – Prescription medication dispensed by the chemist | 2 | 12.45 | 6% | 24.90 |
| 02 | Metformin 850 mg tablets (60 tablets) – Chronic medication, chemist-dispensed | 1 | 8.70 | 6% | 8.70 |
| 03 | Atorvastatin 20 mg film-coated tablets (30 tablets) – Chemist pharmacy supply | 1 | 6.35 | 6% | 6.35 |
| 04 | Pharmaceutical consultation and medication review by the chemist (Brussels pharmacy service) | 1 | 15.00 | 6% | 15.00 |
| 05 | Topical corticosteroid cream 0.1% (30 g tube) – Over-the-counter, sold by the chemist | 1 | 9.80 | 6% | 9.80 |
| 06 | Pharmacy compounding service – Custom preparation of liquid suspension by the chemist | 1 | 22.50 | 6% | 22.50 |
| 07 | Vitamin D3 2000 IU softgel capsules (90 capsules) – Chemist health supplement | 1 | 14.20 | 6% | 14.20 |
| 08 | Pharmacy delivery service within Brussels municipality – Chemist home delivery | 1 | 5.00 | 6% | 5.00 |
| Subtotal (excl. VAT) | 106.45 |
| VAT at 6% (Belgian pharmaceutical rate) | 6.39 |
| RIZIV / INAMI reimbursement | -58.95 |
| Grand Total Due (EUR) | 53.89 |
Notes & Legal Information
This invoice is issued by Pharmacie du Sablon, a registered chemist (pharmacy) operating in Brussels, Belgium, in accordance with the Belgian Royal Decree of 26 March 2010 on the practice of pharmacy and the Belgian Code of Economic Law.
All prescription medications listed herein were dispensed by the chemist upon presentation of a valid prescription from a licensed Belgian physician. The chemist has verified the patient's identity and insurance status through the RIZIV/INAMI electronic system prior to dispensing.
The VAT rate of 6% applies to all pharmaceutical products and pharmacy services as mandated by Belgian tax law (Article 106 of the Belgian VAT Code). This invoice complies with the invoicing obligations set forth in the Belgian Code of Economic Law, Book I, Title IV.
The client acknowledges that this invoice from the chemist constitutes the official record of the transaction and may be submitted to their health insurance provider for reimbursement of the co-payment portion.
Payment Instructions
Please settle the outstanding balance of EUR 53.89 within 30 days of the invoice date (by 15 July 2025).
Payment may be made via bank transfer to the following account of the chemist:
IBAN: BE 68 5390 0754 7034
BIC/SWIFT: GEBABEBB
Reference: INV-2025-00847
Alternatively, payment in cash, by bank card, or via Bancontact is accepted at the chemist's counter located at 12, Rue du Sablon, 1000 Brussels, Belgium. The pharmacy is open Monday through Saturday, 09:00–18:30.
In the event of late payment, statutory interest of 10% per annum shall apply as per Belgian law. A late payment fee of EUR 5.00 per reminder letter may be charged in accordance with Article 5:110 of the Belgian Code of Economic Law.
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