Tax Invoice (ORIGINAL FOR RECIPIENT) Dilbagh Motors -Khatima Involce No Dated Khatima 79 10-May-2021 Uttarakhand Delivery Note Mode/Terms of Payment GSTIN/UIN 05ASVPS1261Q1ZV State NameUttarakhand,Code05 Suppliet's Ref. Other Reference(s) 79/2021-22 Buyer Buyer's Order No Dated Shri Ram Motors -Sitarganj Near L.i.C.Kichha Bypass Sitarganj Despatch Document No. Delivery Note Date U.S.Nagar GSTIN/UIN 05AEDFS3938N1ZL Despatched through Destination State Name Uttarakhand,Code 05 Terms of Detivery SI Description of Goods No. GST Quantity Rate per Amount Rate 1 Front Bumper 2 Grrile Front Bumper RH Cover 28% 1.00 pcs 1.402.34 pcs 1,402.34 3 Grrile Front Bumper CTR 28% 1.00pcs 55.47 pcs 55.47 4 Lamp Assy Rear Comb LH 28% 1.00pcs 335.94 pcs 335.94 5 Lamp Assy Rear Comb RH 18% 1.00pcs 999.15 pcs 999.15 6 Rear Bumper 18% 1.00pcs 999.15 pcs 999.15 28% 1.00pcs 1,402.34 pcs 1,402.34 5.194.39 CGST 627.30 SGST 627.30 Round Off 0.01 Total 6.00 pcs 6,449.00 Amount Chargeable (in words) E&OE INR Six Thousand Four Hundred Forty Nine Only HSNISAC Taxable Central Tax State Tax Total Value Rate Amount Rate Amount Tax Amount 8708 1.402.34 14% 196.33 14% 196.33 1.793.75 14% 392.66 251.13 14% 251.13 502.26 1,998.30 9% 179.84 9% 179.84 359.68 Total 5,194.39 627.30 627.30 1,254.60 Tax Amount (in wordsINR One Thousand Two Hundred Fifty Four and Sixty paise Only Company's Bank Details Bank Name PUNJAB NATIONAL BANK,KHATIMA A/cNo. 06804011000547 Branch&IFS CodeKHATIMA&PUNB0068010 Declaration We declare that this invoice shows the actual price of the goods forDilbagh Motors -Khatima described and that all particulars are true and correct. AuthertSed Signatory --------------PAGE END-----------------------