Invoice Ophthalmologist in Algeria Algiers –Free Word Template Download with AI
Specialized Eye Care & Vision Surgery
12 Rue Didouche Mourad, Hydra
Algiers, Algeria
Phone: +213 21 60 12 34
Email: [email protected]
NIF: 000123456789012 | NIS: 000123456789012
RC: 16/00-1234 B 12
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Currency: Algerian Dinar (DZD)
Bill To:
Patient Name: Mr. Karim Hadjadj
Address: 45 Boulevard Mohamed V, El Mouradia
City: Algiers, Algeria
Phone: +213 555 123 456
Email: [email protected]
Insurance Provider: CNAS (Caisse Nationale des Assurances Sociales)
Policy Number: CNAS-ALG-789456
| Description of Services | Quantity | Unit Price (DZD) | Total (DZD) |
|---|---|---|---|
| Comprehensive Ophthalmological Examination | 1 | 5,000 | 5,000 |
| Retinal Imaging (OCT Scan) | 1 | 8,000 | 8,000 |
| Visual Field Test (Perimetry) | 1 | 4,500 | 4,500 |
| Prescription Eyeglasses (High-Index Lenses) | 1 | 15,000 | 15,000 |
| Anti-Reflective Coating for Lenses | 1 | 3,000 | 3,000 |
| Follow-up Consultation | 1 | 3,500 | 3,500 |
| Eye Drops (Prescription Medication) | 2 | 1,200 | 2,400 |
| Subtotal: | 41,400 DZD |
| VAT (19%): | 7,866 DZD |
| Total Amount Due: | 49,266 DZD |
Payment Instructions:
Please make payment within 30 days of the invoice date. Payments can be made via bank transfer, cash, or credit card at our clinic in Algiers.
Bank Details:
Bank Name: BNA (Banque Nationale d'Algérie)
Account Name: Dr. Amine Benali - Ophthalmology Center
Account Number: 0001234567890123456
IBAN: DZ000001234567890123456789
SWIFT/BIC: BNADZZAA
Terms and Conditions:
1. This invoice is issued in accordance with Algerian tax regulations and applies to services rendered at our clinic in Algiers, Algeria.
2. Late payments may incur a penalty of 2% per month on the outstanding balance.
3. Insurance claims should be submitted directly to the respective provider with a copy of this invoice.
4. All services provided are subject to the professional standards of ophthalmology practiced in Algeria.
5. Please retain this invoice for your records and for any future reference regarding your eye care treatment.
Authorized Signature
Dr. Amine Benali
Ophthalmologist
Patient Acknowledgment
Signature: ___________________
Date: ___________________
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