ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID : 02-14 Invoice No. : 001/BI/20000107 Date : 30/06/2020 18:33:04 Bajaj Allianz General Insurance Co. Ltd, N-A/7,Irrigation Dept., Employees Co-operative, Society,Chitragupt Job Card No.: JC20000372 Job Card Date: 30/06/2020 Nagar Reg.No. : BR01AR6838 Mileage: 35583 PATNA SA Name : AMRESH KUMAR DWIVEDI SA(M) : 9334656236 Pin:800020 State & Code : 10-BIHAR ModeI : WAGON R LXI BS III (WITH EW Type : NA Mobile Chassis No.: 862696 Last Service : 7356 (07-10-12) Loyalty Card : NA Fuel Trim : Next Service Due : PMS 30 Service type: BODY REPAIR Cust GSTIN/UIN : 10AABCB5730G1ZC Place of Supply: BIHAR Ins.Comp. : BAJAJ Surveyor Name : Srl. Part Number Description Batch HSN/SAC Tax Qty. Rate Taxable Tax Paid Labour Amount Amount Charges Parts Demanded Repairs-Others/Suggested Jobs 1 35121M67K00 UNIT HEADLAMP RH,WAG R MINOR AB 8512 18% 1.000 2648.30 1324.15 0.00 INSURANCE 50 2 71711M67K00-5PK BUMPER FRONT AB 8708 28% 1.000 1406.25 703.13 0.00 INSURANCE 50 3 71741M67K00 GRILLE FR BUMPER UPP AB 8708 28% 1.000 382.81 191.41 0.00 INSURANCE 50 4 71751M67K00 GRILLE RADIATOR LOWE AC 8708 28% 1.000 214.84 107.42 0.00 INSURANCE 50 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF16D0 PANEL FRONT FENDER RH DENTING 998729 450.00 2 ZF16P0 PANEL FRONT FENDER RH PAINTING 998729 2,268.00 3 ZF01D0 PANEL, FRONT HOOD DENTING 998729 500.00 4 ZA64L0 OUT SIDE LABOUR 998729 450.00 5 ZF27P0 FRONT BUMPER PAINTING 998729 2,835.00 6 ZF02D0 MEMBER FRONT UPPER DENTING 998729 800.00 7 ZF01P0 PANEL, FRONT HOOD PAINTING 998729 2,917.25 Sub Total Amount 2,326.11 0.00 10,220.25 CGST @ 14% 140.28 SGST @ 14% 140.28 CGST @ 9% 119.17 919.82 SGST @ 9% : 119.17 919.82 For TIRUPATI AUTO Sub Total Amount 2,845.01 0.00 12,059.89 Authorised Signatory Deductibles(As per policy T & C) 1,000.00 ): Dealer GSTIN : 10AACFT2338Q1Z4 Net Bill Amount (Rounded) 13,905.00 Rupees Thirteen Thousand Nine Hundred And Five Only * I acknowledge that the jobs/repairs/service carried out in my vehicle and the respective cost estimates were explained to me. I have received my vehicle after completion of all repairs being carried out to my satisfaction and I confirm that my vehicle is in good condition. I further authorize this workshop to contact me by call or sms to Customer Signature Mobile No.: inform me with any other information in relation to my vehicle. Gate Pass GP No. : GP20000365 Date : 30-JUN-20 18:33:17 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : WAGON R JC20000372 BR/20000110 30-JUN-20 5,197.00 Tech. Name :IRSHAD ALAM Reg.No.: BR01AR6838 JC20000372 BI/20000107 30-JUN-20 13,905.00 Customer Signature Accountant Signature JC20000372 ---PAGE END---