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WELCOME HEALTHCARE
43 Broadway Shopping Centre Dr.B.A Road Dadar T.T Mumbai 400014 INDIA

PRO FORMA INVOICE
Bill To:
ALEXEY VASILEV
164500 RUSSIA
SEVERODVINSK
LEBEDEVA 10,2

Ship To:
ALEXEY VASILEV
164500 RUSSIA
SEVERODVINSK
LEBEDEVA 10,2

Page:
Date:
Date of Expiry:
Invoice #:
Customer ID:

1 of 1
January 13, 2016
January 13, 2016
3989
12163

Shipment Information
P.O. #:

Mode of Transportation:

P.O. Date:

Transportation Terms:

Letter of Credit #:

Number of Packages:

Currency:

INR

Est. Gross Weight:

Payment Terms:

Advance Payment

Est Net Weight:

Est. Ship Date:

Carrier:

240.00 gms

DHL

Additional Information for Customs
FREE TRADE SAMPLE FOR PERSONAL USE.

Reason for Export:
Port of Embarkation:

Item/Part #
2277

Port of Discharge:

India

Country of Origin:

UOM

AWB/BL #:

Unit Price

Description

DIETARY SUPPLEMENTS

995.00

PAYMENT DETAILS
A/c Name :- WELCOME HEALTHCARE
Bank Name:- IDBI BANK LTD
Swift Code:- IBKLNBB004
Bank Address:-5,Wadala Udyog Bhavan,Naigaon Cross Rd,Mumbai

Subtotal
Subject to Sales Tax
Sales Tax Rate
Sales Tax
S&H
Insurance
[Other] specify
[Other] specify
[Other] specify
Total

VAT TIN NO :- 27090883617V
DL NO :- 20B-MH-MZ4-40023 21B-MH-MZ4-40024

I declare that the information mentioned above is true and correct to the best of my knowledge.
Signature

Date

Qty

Sales
Tax

1

v

Line Total
995.00
-

$
$

995.00
995.00
-

$
$
$
$
$
$
$

995.00