Tax Invoice AJAY MOTOR'S Invoice No. Dated 117/H-2/14 PANDU NAGAR KANPUR 136 12-Dec-2020 GSTIN/UIN: 09CDEPM9442D1ZF Delivery Note Mode/Terms of Payment State Name : Uttar Pradesh, Code : 09 Supplier's Ref. Other Reference(s) 136 Buyer's Order No. Dated Buyer Bajaj Allianz General Insurance Com Ltd Despatch Document No. Delivery Note Date Bajaj Allianz House ,Airport Road ,Yarwada Pune Name Amit Pandey Despatched through Destination Add 7/122 Swaroop Nagar Kanpur UP78-BS27005 Wagon-R Terms of Delivery Mob 7755001709 GSTIN/UIN : 27AABCB5730G1ZX State Name : Maharashtra, Code : 27 SI Description of HSN/SAC Quantity Rate per Disc. % Amount No. Goods and Services 1 BONAT 8708 1 PCS 2,382.81 PCS 2,382.81 2 RH HEAD LIGHT 8512 1 PCS 2,835.59 PCS 2,835.59 3 Crossmember 8708 1 PCS 1,232.81 PCS 1,232.81 4 Upper Funty 8708 1 PCS 570.31 PCS 570.31 5 FENDER LINER 8708 1 PCS 238.28 PCS 238.28 6 A.C.GAS CHARGING 9985 1,050.00 7 REPAIRING 9918 600.00 Condenser Repairing 8 CHANGING 9918 350.00 Bonat Changing 9 Denting 998516 400.00 Rh Fender Denting continued ... ---PAGE END--- Tax Invoice(Page 2) AJAY MOTOR'S Invoice No. Dated 117/H-2/14 PANDU NAGAR KANPUR 136 12-Dec-2020 GSTIN/UIN: 09CDEPM9442D1ZF Delivery Note Mode/Terms of Payment State Name : Uttar Pradesh, Code : 09 Supplier's Ref. Other Reference(s) 136 Buyer's Order No. Dated Buyer Bajaj Allianz General Insurance Com Ltd Delivery Note Date Despatch Document No. Bajaj Allianz House ,Airport Road ,Yarwada Pune Name Amit Pandey Despatched through Destination Add 7/122 Swaroop Nagar Kanpur UP78-BS27005 Wagon-R Terms of Delivery Mob 7755001709 GSTIN/UIN : 27AABCB5730G1ZX State Name : Maharashtra, Code : 27 SI Description of HSN/SAC Quantity Rate perDisc. % Amount No. Goods and Services 10CHANGING 9918 600.00 Cross Member Changing CHANGING 9918 300.00 Upper Funty Changing 12Painting 9985 2,500.00 Bumper & Partial Door Painting 13Painting 9985 2,500.00 Rh Door Painting 14Painting 9985 1,900.00 R H Fender Painting 15Denting 998516 250.00 Door Denting continued ... ---PAGE END--- Tax Invoice(Page 3) AJAY MOTOR'S Invoice No. Dated 117/H-2/14 PANDU NAGAR KANPUR 136 12-Dec-2020 GSTIN/UIN: 09CDEPM9442D1ZF Delivery Note Mode/Terms of Payment State Name : Uttar Pradesh, Code : 09 Supplier's Ref. Other Reference(s) 136 Buyer's Order No. Dated Buyer Bajaj Allianz General Insurance Com Ltd Delivery Note Date Despatch Document No. Bajaj Allianz House ,Airport Road ,Yarwada Pune Name Amit Pandey Despatched through Destination Add 7/122 Swaroop Nagar Kanpur UP78-BS27005 Wagon-R Terms of Delivery Mob 7755001709 GSTIN/UIN : 27AABCB5730G1ZX State Name : Maharashtra, Code : 27 SI Description of HSN/SAC Quantity Rate perDisc. % Amount No. Goods and Services 17,709.80 IGST 3,630.20 Total 5 PCS ? 21,340.00 Amount Chargeable (in words) E. & O.E INR Twenty One Thousand Three Hundred Forty Only HSN/SAC Taxable Integrated Tax Total Value Rate Amount Tax Amount 8708 4,424.21 28% 1,238.79 1,238.79 8512 2,835.59 18% 510.41 510.41 9985 7,950.00 18% 1,431.00 1,431.00 9918 1,850.00 18% 333.00 333.00 998516 650.00 18% 117.00 117.00 Total 17,709.80 3,630.20 3,630.20 Tax Amount (in words) : INR Three Thousand Six Hundred Thirty and Twenty paise Only Declaration for AJAY MOTOR'S We declare that this invoice shows the actual price of the goods described and that all particulars are true and correct. Authorised Signatory ---PAGE END---