Goods & Services Tax Invoice Insurance Invoice ( Part ) HYUNDAI SUJAYA ENTERPRISES PVT. LTD. NEAR RELIANCE PETROL PUMP,CIDCO ROAD GUT NO.65,66,WASARANI, NANDED Ph: 9168602025 GST No: 27AALCS1794D1Z4 Bajaj Allianz General Insurance Company Limited 952/954, APPASAHEB MARATHE MARG,NEAR Reg No : MH12GF5838 Invoice No : W2216G202102485 CHAITNYA TOWER.PRABHADEVI, MUMBAI - VIN MALAM51CLAM703074 Date : 23.02.2021 MUMBAI Mileage : 80260 R/O No : R202101319 Maharashtra Place of Supply : Maharashtra Payment : Credit GST No: 27AABCB5730G1ZX S.No. Part No. Part Description HSN Tax % Qty Rate/Unit Ins ShareAmount 1 7935921000 BOLT 73181500 18% 5.00 9.32 100.00% 46.61 2 291200X000 COVER-ENGINE UNDER,RH 87089900 28% 1.00 353.12 100.00% 353.12 3 865120X000 COVER-FR BUMPER 87089900 28% 1.00 1,322.66 100.00% 1,322.65 4 865920X000 RETAINER-FR BPR SIDE BRKT 87089900 28% 1.00 72.66 100.00% 72.65 5 1244106167B T/SCREW-HEXAGON HEAD 73181500 18% 4.00 16.94 100.00% 67.75 6 865840X000 COVER-FOG LAMP HOLE,RH 87089900 28% 1.00 35.16 100.00% 35.16 7 641010X000 CARRIER ASSY-FRONT END 87089900 28% 1.00 5,952.34 100.00% 5,952.33 8 865910X000 RETAINER-FR BPR SIDE BRKT, LH 87089900 28% 1.00 72.66 100.00% 72.65 9 1244106207B SCREW-TAPPING 73181400 18% 6.00 12.72 100.00% 76.31 10 865830X000 COVER-FOG LAMP HOLE,LH 87089900 28% 1.00 35.16 100.00% 35.16 Special Comment:-The below mentioned Non-Genuine Fitments may Hamper your Safety and/or Result in Poor Performance of your vehicle. HMIL is not Responsible for any untoward incident due to the same. Kindly return the vehicle to its Original Condition as per HMIL specifications. Observation: No Accessory Fitment Additional Information: Pending Jobs Sub Total 8,034.39 Coupon Discount 0.00 TCS Tax 0.00 Discount 0.00 AMC Discount 0.00 CGST@9% ON Part Value of 190.67 17.16 SGST@9% ON Part Value of 190.67 17.16 CGST@14% ON Part Value of 7843.72 1,098.12 SGST@14% ON Part Value of 7843.72 1,098.12 Total 10,264.95 Grand Total (Rounded) 10265 Rupees Ten Thousand Two Hundred Sixty Five Rupees Only For SUJAYA ENTERPRISES PV (Authorized Signatory) Thank you for making Hyundai a Leader in Customer Service for three years in a row. ---PAGE END---