Léa Exemple

Speech therapist, INAMI no. 6-00011-31-111

Rue de la Démonstration 1, 1000 Bruxelles

Tel. 0400 00 00 00 · lea@example.org

Enterprise no. 0123.456.749

To the parents of Bastin Nour

For the attention of Parent de Nour

Rue de l'Exemple 1

1000 Bruxelles

Speech therapy invoice

No. 2026-002 · Issued on 25/10/2026

Sessions of September 2026

Patient and prescription

Total fees (4 sessions)	153,48 €
Amount to be paid by the patient	153,48 €

BIM patient: no. Enterprise no. 0123.456.749.

Healthcare services exempt from VAT (article 44, § 1, paragraph 1, 1°, of the VAT Code).

Léa Exemple, speech therapist, INAMI no. 6-00011-31-111, certifies having provided the services listed above.

Date:

Signature of the provider: