Date:
Name of the Supervisor: ............................................	Name of the Student: ......................................................
Department: ...............................................................	Institute: ..........................................................................
Email: ......................................................................... 	Contact Number(s): ........................................................
Details of samples submitted: Please provide the following details
S. No.	Sample code	Molecular formula	Molecular mass (m/z)	Solubility	

					

					

Details of Payment:
Total No. of Samples	Charge per Sample (Rs.)	Sub Total (Rs.)	GST	Total (Rs.)	
			SGST (9%)	CGST (9%)	IGST (18%)		

							
Note: 1) GST is not applicable if source of funding is special contingency/PDF fund of BITS Pilani.
2) IGST is applicable only when service provided out of state. Please state NA wherever SGST/ CGST/ IGST is not applicable.
Date:								                 Signature of the supervisor
Receipt No:	
To 										Date:
HAF, BITS Pilani
Kindly collect Rs. ____________ from _______________________towards the charges for HRMS analysis and GST. Deposit the subtotal amount Rs. _____________ for HRMS charges in the account head “7/3/216 Budget Income – QTR LIC & OTH (Other income HRMS Chemistry)” with Total GST (18%) paid Rs._____________.
Regards
In-charge, HRMS Facility.