SAMPLE: Your shop name
Address: Shop address, City, PIN
Phone: 98xxxxxxxx
GSTIN: 24AAAAA0000A1Z5
State: Gujarat (24)
Drug licence no. (Form 20/21): XX-XXX-20/21-0000
TAX INVOICE
ORIGINAL FOR RECIPIENT
| # | Description | HSN | Batch | Expiry | Mfr. | Qty | Unit | Rate (₹) | Disc. % | Taxable value (₹) | GST % | CGST (₹) | SGST (₹) | Amount (₹) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Paracetamol 650 mg tab (15) | 3004 | PCM2409 | 08/27 | Sample Pharma | 2 | strip | 28.57 | - | 57.14 | 5% | 1.43 | 1.43 | 60.00 |
| 2 | Amoxicillin 500 mg cap (10) Sch. H | 3004 | AMX1123 | 11/26 | Sample Labs | 1 | strip | 95.24 | - | 95.24 | 5% | 2.38 | 2.38 | 100.00 |
| 3 | Cough syrup 100 ml | 3004 | CS0525 | 05/27 | Sample Pharma | 1 | btl | 104.76 | - | 104.76 | 5% | 2.62 | 2.62 | 110.00 |
| 4 | Digital thermometer | 9025 | - | - | Sample Devices | 1 | pcs | 190.48 | - | 190.48 | 5% | 4.76 | 4.76 | 200.00 |
Amount in wordsRupees Four Hundred Seventy Only
Medicines sold on prescription: dispensed by or under the supervision of the registered pharmacist signing below.
- Taxable value
- 447.62
- CGST
- 11.19
- SGST
- 11.19
- Total
- ₹470.00
Registered pharmacist
Authorised signatory
Sample rows and rates for the layout (rates from 22 Sep 2025). Check the GST rate for your own HSN. Free format from richdaddy.in/bill-format/medical-store