ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail -Tax Invoice Customer Name & Address : ID02-13 Invoice No.:1/BI/21000002 Date : 01/04/2021 17:37:06 Bajaj Allianz General Insurance Co. Ltd, 6th Floor,Mani Square,No 164, Manicktala Main Rd,Mani Square, Job Card No.:JC20006126 Job Card Date:30/03/2021 Premises No 41,Canal Circle Rd Reg.No. : WB40Z0583 Mileage:29671 KOLKATA SA Name : MADHU MANGAL SANTRA SA(M):8145764583 Pin:700156 Model : MARUTI SWIFT VXI BS IV EW Type:NA State&Code19-WEST BENGAL Chassis No.: 525145 Last Service : 25603 (06-09-20) Mobile Next Service Due:PMS70 Loyalty CardNA Fuel Trim: Service type: BODY REPAIR Cust GSTIN/UIN 19AABCB5730G1ZU Place of Supply: WEST BENGAL 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 35321M74L01 UNIT,HEADLAMP LH AC. 85122010 18% 1.000 2080.50 2080.50 0.00 2 35500M75J11 FRONT FOG LAMP,YN4 AC 87089900 18% 1.000 940.67 940.67 0.00 3 71711M74L00 BUMPER FRONT AC 87081090 28% 1.000 1437.50 1437.50 0.00 4 71721M68L00-5PK GRILLE, RADIATOR LOWER (BLACK) AC 87089900 28% 1.000 195.31 195.31 0.00 5 71731M74L00 HOLDER,FR BUMPER SIDE RH AC 87089900 28% 1.000 75.78 75.78 0.00 6 71732M74L00 HOLDER,FR BUMPER SIDE LH AC 87089900 28% 1.000 75.78 75.78 0.00 7 84702M74LC1-5PK MIRROR ASSY,OUT REAR VIEW,L AC 87089900 18% 1.000 3961.86 3961.86 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 ZA7OLO BOLT REMOVING CUTTING 998729 650.00 2 ZF9993 PAINTING CHARGES 998729 13,169.00 3 ZF9992 DENTING CHARGES 998729 900.00 Sub Total Amount 8,767.40 0.00 14,719.00 CGST @14% 249.81 SGST @14% 249.81 Quic CGST @ 9% 628.48 1,324.71 SGST @ 9% 628.48 1,324.71 For THE QUICKEST Tax Collection at Source 10.54 Authorised Signafory Sub Total Amount 10,534.52 0.00 17,368.42 Dealer GSTIN19AEUPB0339R1ZU mC Net Bill Amount (Rounded) 27,903.00 Rupees Twenty Seven Thousand Nine Hundred And Three 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. GP21000010 Date 01-APR-21 17:37:14 Job Card No. Bill.No. Bill Date Amount Cust.NameBajaj Allianz General Insurance Co.LModel:SWIFT NEW/DZIRE NEW PETROL JC21000006 BC/21000008 01-APR-21 11,156.00 Tech.Name:EKLAKH SEKH Reg.No.: WB40Z0583 JC20006126 BR/21000003 01-APR-21 0.00 JC20006126 BI/21000002 01-APR-21 27.903.00 Customer Signature Accountant Signature JC20006126 --------------PAGE END-----------------------