ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID :02-23 Invoice No. : 1/BI/22000023 Date : 02/05/2022 10:08:15 Bajaj Allianz General Insurance Co. Ltd, 401, Atlantis Heritage, Opp : Swagat Petrol Pump., Sarabhai Main Job Card No.: JC22000112 Job Card Date: 22/04/2022 Rd, Reg.No. : GJ07DA6171 Mileage: 48015 VADODARA SA Name : NILAY MEHTA SA(M) : 7284075960 Pin:390007 State & Code : 24-GUJARAT Model : MARUTI SWIFT DZIRE VDI EW Type : NA Mobile Chassis No.: 988679 Last Service : 47706 (28-03-22) Loyalty Card : 33029513588 Fuel Trim : Next Service Due : PMS 50 Service type: BODY REPAIR Cust GSTIN/UIN : 24AABCB5730G1Z3 Place of Supply: GUJARAT 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 01550M0616A BOLT AD 73181500 28% 4.000 3.90 15.60 0.00 2 03141M05165 .SCREW AC 73181500 18% 6.000 3.38 20.28 0.00 3 09409M07L01 CLIP AC 87082900 28% 4.000 3.90 15.60 0.00 4 13620M60M50 COOLER, INTER AE 87089900 28% 1.000 4355.46 4355.46 0.00 5 35500M75J11 FRONT FOG LAMP,YN4 AE 85122020 18% 1.000 1016.94 1016.94 0.00 6 71711M84P00-5PK BUMPER, FRONT (BLACK) AE 87081090 28% 1.000 1480.46 1480.46 0.00 7 71721M84P00-5PK GRILLE, RADIATOR LOWER (BLACK) AE 87089900 28% 1.000 226.56 226.56 0.00 8 72460M74L00 COVER COMP,FR BUMPER LOWER AE 87089900 28% 1.000 179.68 179.68 0.00 9 95310M74L00 CONDENSER ASSY AE 84159000 28% 1.000 4667.96 4667.96 0.00 10 990J0M999H4-050 AC CAN GAS (450GM) SRF AB 29034500 18% 1.000 394.06 394.06 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF9993 PAINTING CHARGES 998729 2,863.00 2 ZF9992 DENTING CHARGES 998729 1,550.00 Sub Total Amount 12,372.60 0.00 4,413.00 total pay cus CGST @ 14% 1,531.77 SGST @ 14% 1,531.77 CGST @ 9% 128.82 397.17 SGST @ 9% : 128.82 397.17 For SHIVAM MOTORS Sub Total Amount 15,693.78 0.00 5,207.34 Authorised Signatory Net Bill Amount (Rounded) 20,901.00 Dealer GSTIN : 24AEIPP4175M3ZZ Rupees Twenty Thousand Nine Hundred And One Only * This is a system generated soft copy of invoice for insurance company records. 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. : GP22000138 Date : 02-MAY-22 10:08:41 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : SWIFT NEW/ DZIRE NEW DIESEL JC22000112 BI/22000023 02-MAY-22 20,901.00 Tech. Name :SOLANKI MAHENDRA V Reg.No.: GJ07DA6171 Customer Signature Accountant Signature JC22000112 ---PAGE END---