Invoice Chemist in Senegal Dakar –Free Word Template Download with AI
Chemist & Pharmaceutical Services
142 Avenue Cheikh Anta Diop
Plateau, Senegal Dakar 10000
Tel: +221 33 821 45 67
Email: [email protected]
RC: SN-DKR-2019-004521
NIF: 00452100001234
Billed To
Client Name: M. Amadou Diallo
Address: 27 Rue de la République
Yoff, Senegal Dakar 16000
Phone: +221 77 654 32 10
Email: [email protected]
National ID: SN-1985-004521
Prescribing Physician
Dr. Fatou Ndiaye
Centre Hospitalier National
Fann, Senegal Dakar
License No: MED-SN-2010-0892
Prescription Date: 12 June 2025
Prescription Validity: 30 days
| # | Description of Pharmaceutical Item | Product Code | Quantity | Unit Price (XOF) | Amount (XOF) |
|---|---|---|---|---|---|
| 1 | Amoxicillin 500mg Capsules – 21 capsules per blister, 3 blisters (Antibiotic, prescribed for respiratory infection) | CHM-AMX-500-21 | 3 | 4,500.00 | 13,500.00 |
| 2 | Paracetamol 1000mg Tablets – 100 tablets per bottle (Analgesic and antipyretic, over-the-counter) | CHM-PCM-1000-100 | 2 | 3,200.00 | 6,400.00 |
| 3 | Metformin 850mg Tablets – 60 tablets per strip, 2 strips (Antidiabetic medication, prescription required) | CHM-MTF-850-60 | 2 | 5,800.00 | 11,600.00 |
| 4 | Ibuprofen 400mg Tablets – 30 tablets per box (Non-steroidal anti-inflammatory, over-the-counter) | CHM-IBU-400-30 | 1 | 2,750.00 | 2,750.00 |
| 5 | Oral Rehydration Salts (ORS) – 20 sachets per box (Electrolyte replacement, WHO-recommended formulation) | CHM-ORS-20 | 2 | 1,800.00 | 3,600.00 |
| 6 | Vitamin D3 1000 IU Softgels – 90 capsules per bottle (Supplement, over-the-counter) | CHM-VTD3-1000-90 | 1 | 8,500.00 | 8,500.00 |
| 7 | Medical Surgical Gloves, Medium – Box of 100 (Protective equipment, over-the-counter) | CHM-GLV-MED-100 | 1 | 4,200.00 | 4,200.00 |
| 8 | Digital Thermometer, Infrared Forehead Type (Medical device, over-the-counter) | CHM-THM-IR-01 | 1 | 12,000.00 | 12,000.00 |
| Subtotal | 62,550.00 XOF |
| VAT (18% – Senegal Standard Rate) | 11,259.00 XOF |
| Pharmacist Dispensing Fee | 1,500.00 XOF |
| Delivery Fee (Senegal Dakar Metro Area) | 2,000.00 XOF |
| Grand Total Due | 77,309.00 XOF |
Invoice Notes & Chemist Disclaimer
- This Invoice has been issued by Pharmacie du Chemist, a licensed chemist and pharmacy operating in Senegal Dakar, in full compliance with the Senegalese Ministry of Health regulations (Code de la Santé Publique du Sénégal).
- All prescription items listed on this Invoice were dispensed under the direct supervision of a registered pharmacist (Licence No: PHARM-SN-2015-0234) and in accordance with the original prescription provided by the prescribing physician.
- The Chemist reserves the right to verify the authenticity of all prescriptions presented at the point of sale. No prescription medication will be dispensed without a valid, unexpired prescription from a licensed medical practitioner in Senegal.
- All pharmaceutical products listed on this Invoice are sourced from authorized distributors and carry valid batch numbers and expiration dates. The Chemist guarantees the integrity and quality of all products dispensed.
- Payment is due within fifteen (15) calendar days from the date of issue of this Invoice. Late payments may incur a penalty of 1.5% per month as stipulated under Senegalese commercial law.
- For any questions regarding this Invoice, please contact the Chemist at the address or phone number listed above. Our office is open Monday through Saturday, 08:00 to 20:00, and Sunday 09:00 to 14:00.
- This Invoice serves as the official record of the transaction between the Chemist and the client. Please retain this document for your personal records, insurance claims, or any regulatory audit purposes within Senegal.
Payment Instructions
Bank Transfer: Bank of Senegal (BCEAO) – Account Name: Pharmacie du Chemist – IBAN: SN09 0002 0001 0000 4521 0000 1234 – BIC: BCEOSNDD
Mobile Money: Orange Money / Wave – +221 77 654 32 10 (Pharmacie du Chemist)
In-Store Payment: Cash, bank card, or cheque accepted at our Senegal Dakar location on Avenue Cheikh Anta Diop.
Reference for Payment: Please include Invoice number INV-2025-00847 as the payment reference to ensure proper accounting.
Chemist Signature & Stamp Client Acknowledgment ⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
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