ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID :02-12 Invoice No. : 008/BI/20000115 Date : 29/06/2020 Bajaj Allianz General Insurance Co. Ltd, HIG 10 1st Shivaji Nagar, Opp Pragati Petrol Pump Job Card No.: JC20000290 Job Card Date : 03/06/2020 BHOPAL Reg.No. : DMY529954 Mileage :333367 Pin:462016 SA Name : CHANDRESH JAIN State & Code :23-MADHYA PRADESH Model : MARUTI DZIRE VDI EW Contract No. : 199056860 Mobile Chassis No.: 529954 Loyalty Card : 33054298618 Fuel Trim : Service type : BODY REPAIR Ins.Comp. BAJAJ Place of Supply : MADHYA PRADESH Cust GSTIN/UIN : 23AABCB5730G1Z5 Srl. Part Number Description Batch HSN/SAC Tax Qty. Rate Taxable Tax Paid Labour Amount Amount Charges Parts Demanded Repairs-Others/Suggested Jobs 1 11141M86J20-0A0 GASKET, CYL HEAD TO . 72 AB 8484 18% 1.000 500.00 500.00 2 11510M86J30 PAN, OIL AB 8708 28% 1.000 484.37 484.37 3 12140M53M00 RING SET,PISTON AB 8708 28% 3.000 195.31 585.93 4 12140M86J40 RING SET AB 8409 28% 4.000 753.90 3015.60 5 12181M68L00-0A0 BEARING, CONROD AB 8708 28% 4.000 273.43 1093.72 6 12182M86J40-0A0 BEARING, CONNROD LOWER (RED) AB 8483 18% 4.000 41.52 166.08 7 12341M86J40-0A0 BEARING, CRANK UPPER (RED) AB 8483 18% 4.000 51.69 206.76 8 12345M86J40-0A0 BEARING, CRANK LOWER (RED) AB 8483 18% 5.000 51.69 258.45 9 12351M86J00-0A0 BEARING COMP,THRUST RED AA 8708 28% 1.000 179.68 179.68 10 12361M86J20 SEAL , CSHAFT OIL REAR AB 8484 28% 1.000 304.68 304.68 11 12761M86J01 CHAIN COMP,TIMING AB 8708 28% 1.000 921.87 921.87 12 12831M86J20 ADJUSTER ASSY,TENSIONER AB 8409 28% 1.000 677.34 677.34 13 12840M86J20 ARM COMP,ROCKER AB 8409 28% 16.000 125.00 2000.00 14 12850M86J20 ADJUSTER,HYDR VALVE LASH AB 8409 28% 16.000 128.90 2062.40 15 12911M86J30 VALVE, INTAKE AA 8409 28% 8.000 129.68 1037.44 16 12915M86J30 VALVE, EXHAUST AB 8409 28% 8.000 185.15 1481.20 17 12919M86J30 SEAL, VALVE STEM AB 8484 18% 16.000 19.49 311.84 18 13119M86J20 GASKET, INTK MANF AB 8708 28% 1.000 333.59 333.59 19 14130M83P50 CASE, CATALYTIC CONV AB 8708 28% 1.000 24640.62 24640.62 20 16119M86J30 GASKET OIL PUMP AB 4016 18% 1.000 498.30 498.30 21 16510M86J20 ELEMENT OIL FILTER AA 8421 18% 1.000 302.54 302.54 22 17400M86J31 PUMP ASSY,WATER AB 8413 28% 1.000 1609.37 1609.37 23 17700M55R50 RADIATOR ASSY AB 8708 28% 1.000 2109.37 2109.37 24 22011M86J82 COVER & CLUTCH SET AB 8708 28% 1.000 2492.18 2492.18 Contd.. 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 (Customer Signature) Mobile No.: to inform me with any other information in relation to my vehicle. Gate Pass GP No. : GP20000770 Date : 29-JUN-20 22:04:41 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance C Model : New Dzire Diesel JC20000290 BI/20000115 29-JUN-20 84,573.00 Tech. Name :CHAND MOHAMMAD Reg No. : DMY529954 JC20000290 BR/20000440 29-JUN-20 4,580.00 Customer Signature Accountant Signature ---PAGE END--- ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID : 02-12 Invoice No. : 008/BI/20000115 Date : 29/06/2020 Bajaj Allianz General Insurance Co. Ltd, HIG 10 1st Shivaji Nagar, Opp Pragati Petrol Pump Job Card No.: JC20000290 Job Card Date : 03/06/2020 BHOPAL Mileage Reg.No. : DMY529954 : 33367 Pin:462016 SA Name : CHANDRESH JAIN State & Code :23-MADHYA PRADESH Model : MARUTI DZIRE VDI EW Contract No. : 199056860 Mobile Chassis No.: 529954 Loyalty Card : 33054298618 Fuel Trim : Service type : BODY REPAIR Ins.Comp. BAJAJ Place of Supply : MADHYA PRADESH Cust GSTIN/UIN : 23AABCB5730G1Z5 Srl. Part Number Description Batch HSN/SAC Tax Qty. Rate Taxable Tax Paid Labour Amount Amount Charges Parts Demanded Repairs-Others/Suggested Jobs 25 71711M56R00-5PK BUMPER,FRONT (BLACK) AB 8708 28% 1.000 1375.00 1375.00 26 90900M10157 DUPONT PAINT MATERIAL 3212 18% 0.682 1694.91 1155.93 27 99000M24120-855 LOCTITE 5900 (50 ML) AB 3214 18% 2.000 618.64 1237.28 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF27P0 FRONT BUMPER PAINTING 998729 3,448.00 2 CA01R1 RADIATOR ASSY FOR DIESEL 998729 592.00 3 TB06R1 CONDENSER ASSY FOR DIESEL 998729 592.00 4 CB01R1 RADIATOR FAN ASSY FOR DIESEL 998729 333.00 5 ZC06L0 LATHE WORK 998729 5,000.00 6 ZA28L0 AC GAS TOP-UP 998729 550.00 7 AA16H0 ENGINE ASSY (DIESEL)-OH 998729 6,290.00 8 NA01R0 FRONT BUMPER 998729 481.00 9 DE10RO INTER COOLER 998729 259.00 Sub Total Amount 51,041.54 17,545.00 claim bajaj allianz surve done by Ravi mahajan sir CGST @ 14% 6,496.62 cl no,oc-21-2301-1827-0000007 sa-Prince SGST @ 14% 6,496.62 pandey CGST @ 9% 417.36 1,579.05 SGST @ 9% 417.36 1,579.05 For SHUBH MOTORS PVT. LTD : Sub Total Amount : 64,869.50 20,703.10 Authorised Signatory Deductibles(As per policy T & C) 1,000.00 Net Bill Amount (Rounded) 84,573.00 Dealer GSTIN : 23AAKCS6187M1ZP ---PAGE END---