Online Payment Remitter Name Relationship with Patient Mobile Email Payment Towards Select Admitted Patient Advance for Admission Other Payment Patient Name MR. NO. Patient’s Address City Country Select Aruba Afghanistan Angola Anguilla Åland Islands Albania Andorra Netherlands Antilles United Arab Emirates Argentina Armenia American Samoa Antarctica French Southern Territories Antigua and Barbuda Australia Austria Azerbaijan Burundi Belgium Benin Burkina Faso Bangladesh Bulgaria Bahrain Bahamas Bosnia and Herzegovina Saint Barthélemy Belarus Belize Bermuda Bolivia Brazil Barbados Brunei Darussalam Bhutan Bouvet Island Botswana Central African Republic Canada Cocos (Keeling) Islands Switzerland Chile China Côte d`Ivoire Cameroon Congo, the Democratic Republic of the Congo Cook Islands Colombia Comoros Cape Verde Costa Rica Cuba Christmas Island Cayman Islands Cyprus Czech Republic Germany Djibouti Dominica Denmark Dominican Republic Algeria Ecuador Egypt Eritrea Western Sahara Spain Estonia Ethiopia Finland Fiji Falkland Islands (Malvinas) Federated States of Micronesia France Faroe Islands Micronesia, Federated States of Gabon United Kingdom Georgia Guernsey Ghana N Guinea Gibraltar Guadeloupe Gambia Guinea-Bissau Equatorial Guinea Greece Grenada Greenland Guatemala French Guiana Guam Guyana Hong Kong Heard Island and McDonald Islands Honduras Croatia Haiti Hungary Indonesia Isle of Man India British Indian Ocean Territory Ireland Iran, Islamic Republic of Iraq Iceland Israel Italy Jamaica Jersey Jordan Japan Kazakhstan Kenya Kyrgyzstan Cambodia Kiribati Saint Kitts and Nevis Korea, Republic of Kuwait Lao People`s Democratic Republic Lebanon Liberia Libyan Arab Jamahiriya Saint Lucia Liechtenstein Sri Lanka Lesotho Lithuania Luxembourg Latvia Macao Saint Martin (French part) Morocco Monaco Moldova Madagascar Maldives Mexico Marshall Islands Macedonia, the former Yugoslav Republic of Mali Malta Myanmar Montenegro Mongolia Northern Mariana Islands Mozambique Mauritania Montserrat Martinique Mauritius Malawi Malaysia Mayotte Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua R Norway Niue Netherlands Nepal Nauru New Zealand Oman Pakistan Panama Pitcairn Peru Philippines Palau Papua New Guinea Poland Puerto Rico Korea, Democratic People`s Republic of Portugal Paraguay Palestinian Territory, Occupied French Polynesia Qatar Réunion Romania Russian Federation Rwanda Saudi Arabia North Sudan South Sudan Senegal Singapore South Georgia and the South Sandwich Islands Saint Helena Svalbard and Jan Mayen Solomon Islands Sierra Leone El Salvador San Marino Somalia Saint Pierre and Miquelon Serbia Sao Tome and Principe Suriname Slovakia Slovenia Sweden Swaziland Seychelles Syrian Arab Republic Turks and Caicos Islands Chad Togo Thailand Tajikistan Tokelau Turkmenistan Timor-Leste Tonga Trinidad and Tobago Tunisia Turkey Tuvalu Taiwan, Province of China Tanzania, United Republic of Uganda Ukraine United States Minor Outlying Islands Uruguay United States Uzbekistan Holy See (Vatican City State) Saint Vincent and the Grenadines Venezuela Virgin Islands, British Virgin Islands, U.S. Viet Nam Vanuatu Wallis and Futuna Samoa Yemen South Africa Zambia Zimbabwe State / Province PIN/ZIP Currency Type Select Albanian Lek Algerian Dinar Argentine Peso Aruba Florin Australian Dollar Bahamian Dollar Bahraini Dinar Bangladesh Taka Barbados Dollar Belarus Ruble Belize Dollar Bermuda Dollar Bhutan Ngultrum Bolivian Boliviano Botswana Pula Brazilian Real British Pound Brunei Dollar Bulgarian Lev Burundi Franc Cambodia Riel Canadian Dollar Cape Verde Escudo Cayman Islands Dollar CFA Franc CFA Franc Chilean Peso Chinese Yuan Colombian Peso Comoros Franc Costa Rica Colon Croatian Kuna Cuban Peso Czech Koruna Danish Krone Dijibouti Franc Dominican Peso East Caribbean Dollar Egyptian Pound El Salvador Colon Eritrea Nakfa Estonian Kroon Ethiopian Birr Euro Falkland Islands Pound Fiji Dollar Gambian Dalasi Ghanian Cedi Gibraltar Pound Guatemala Quetzal Guinea Franc Guyana Dollar Haiti Gourde Honduras Lempira Hong Kong Dollar Hungarian Forint Iceland Krona Indian Rupee Indonesian Rupiah Iran Rial Iraqi Dinar Israeli Shekel Jamaican Dollar Japanese Yen Jordanian Dinar Kazakhstan Tenge Kenyan Shilling Korean Won Kuwaiti Dinar Lao Kip Lebanese Pound Lesotho Loti Liberian Dollar Libyan Dinar Lithuanian Lita Macau Pataca Macedonian Denar Malagasy Franc Malawi Kwacha Malaysian Ringgit Maldives Rufiyaa Maltese Lira Mauritania Ougulya Mauritius Rupee Mexican Peso Moldovan Leu Mongolian Tugrik Moroccan Dirham Mozambique Metical Myanmar Kyat Namibian Dollar Nepalese Rupee Neth Antilles Guilder New Turkish Lira New Zealand Dollar Nicaragua Cordoba Nigerian Naira North Korean Won Norwegian Krone Omani Rial Pacific Franc Pakistani Rupee Panama Balboa Papua New Guinea Kina Paraguayan Guarani Peruvian Nuevo Sol Philippine Peso Polish Zloty Qatar Rial Romanian Leu Russian Rouble Rwanda Franc Samoa Tala Sao Tome Dobra Saudi Arabian Riyal Seychelles Rupee Sierra Leone Leone Singapore Dollar Slovak Koruna Slovenian Tolar Solomon Islands Dollar Somali Shilling South African Rand Sri Lanka Rupee St Helena Pound Sudanese Dinar Surinam Guilder Swaziland Lilageni Swedish Krona Swiss Franc Syrian Pound Taiwan Dollar Tanzanian Shilling Thai Baht Tonga Paanga Trinidad and Tobago Dollar Tunisian Dinar U.S. Dollar UAE Dirham Ugandan Shilling Ukraine Hryvnia Uruguayan New Peso Vanuatu Vatu Venezuelan Bolivar Vietnam Dong Yemen Riyal Zambian Kwacha Zimbabwe Dollar Amount Remarks Can’t read the image? click here to refresh Please confirm that you have read and agreed to the terms & conditions
CONNECT MIOT