ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice IRN : 23eb85a1fe311ca67be3439f0a2aebbdf0a41c11222c78bf9abbbbeb6be36688 Customer Name & Address : ID :02-39 Invoice No. : 3/BI/20002095 Date : 06/01/2021 20:41:24 Bajaj Allianz General Insurance Co. Ltd, 4TH FLOOR, HALWASIYA COMM, HOUSE, HABIBULLAH Job Card No.: JC20011509 Job Card Date: 21/12/2020 ESTATE, 11 MG MARG, HAZRATGANJ, Reg.No. : DL2CAT5012 Mileage : 178816 LUCKNOW SA Name : AMIT CHAUHAN SA(M) : 9917868569 Pin:226001 State & Code :09-UTTAR PRADESH Model : MARUTI ALTO 800 LXI BS EW Type : NA Mobile Chassis No.: 420674 Last Service : 2984 (02-02-16) Loyalty Card : 33011627626 Fuel Trim : Next Service Due : PMS 20 Service type: BODY REPAIR Cust GSTIN/UIN : 09AABCB5730G1ZV PAN : AABCB5730G Place of Supply: UTTAR PRADESH 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 17100M53M00 FAN ASSY,ENG CLG AA 8501 28% 1.000 2348.43 2348.43 0.00 2 17700M53M10 RADIATOR ASSY AC 8708 28% 1.000 1710.93 1710.93 0.00 3 71741M53M00-5PK NET,FRONT BUMPER AB 8708 28% 1.000 523.43 523.43 0.00 4 95126M58J00 BOLT,TENSION ADJUST AA 7318 28% 8.000 11.71 93.68 0.00 5 95310M53M10 CONDENSER ASSY AC 8415 28% 1.000 3042.96 3042.96 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 ZA28L0 AC GAS TOP-UP 998729 1,200.00 2 ZF01D0 PANEL, FRONT HOOD DENTING 998729 500.00 3 TB06R0 CONDENSER ASSY 998729 623.00 4 CA01R0 RADIATOR ASSY 998729 578.50 5 ZF01P0 PANEL, FRONT HOOD PAINTING 998729 2,156.00 Sub Total Amount 7,719.43 0.00 5,057.50 Bajaj , R.D Singh , Anil CGST @ 14% 1,080.72 SGST @ 14% 1,080.72 CGST @ 9% 455.18 SGST @ 9% 455.18 For DEV MOTOR PVT LTD Tax Collection at Source @ 0.075% : 7.40 Authorised Signatory Sub Total Amount 9,888.27 0.00 5,967.86 Dealer GSTIN : 09AABCD7011N1ZK Deductibles(As per policy T & C) 1,000.00 Net Bill Amount (Rounded) 14,856.00 Rupees Fourteen Thousand Eight Hundred And Fifty Six 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. : GP20012158 Date : 06-JAN-21 20:42:06 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : ALT0 800 JC20011509 BI/20002095 06-JAN-21 14,856.00 Tech. Name :AJAY KUMAR Reg.No.: DL2CAT5012 JC20011509 BR/20002095 06-JAN-21 2,119.00 Customer Signature ---PAGE END--- ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice JC20011509 ---PAGE END---