ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID : 02-23 Invoice No. : 004/BI/20000660 Date : 29/09/2020 11:44:25 Bajaj Allianz General Insurance Co. Ltd, 401, Atlantis Heritage, Opp : Swagat Petrol Pump., Sarabhai Main Job Card No.: JC20004780 Job Card Date: 05/09/2020 Rd, Reg.No. : GJ16CH5823 Mileage: 9633 VADODARA SA Name : MANAV JAGDEEP PALEJA SA(M) : 9687651123 Pin:390007 State & Code :24-GUJARAT Model : MARUTI DZIRE VXI EW Type : III Mobile : Chassis No.: 449994 Last Service : 6809 (27-12-19) Loyalty Card : 33049108625 Fuel Trim : Next Service Due : PMS 20 Service type: BODY REPAIR Cust GSTIN/UIN : 24AABCB5730G1Z3 PAN : AABCB5730G Place of Supply: GUJARAT 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 57711M56R10 PANEL,FRONT FENDER,L (ED AB 8708 28% 1.000 835.93 835.93 0.00 COATED) 2 64511M56R00-P41 PANEL, SIDE SILL LH AC 8708 28% 1.000 2800.78 2800.78 0.00 3 77221M55R00 GUARD, SIDE SILL SPLASH, L AC 8708 28% 1.000 97.65 97.65 0.00 4 77851M54G00-0PG EMBLEM, VVT (CHROME) AC 8708 28% 1.000 35.93 35.93 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF9993 PAINTING CHARGES 998729 5,195.00 2 ZF9992 DENTING CHARGES 998729 1,950.00 Sub Total Amount 3,770.29 0.00 7,145.00 Case Number-5428410617 Title-Service CGST @ 14% 527.84 Complaint Region-West-3 SGST @ 14% 527.84 CRM:002905000000740....BAJAJ MI 0337 CGST @ 9% 643.05 MANoJ.... SGST @ 9% 643.05 Sub Total Amount 4,825.97 0.00 8,431.10 Authorised Signatory Deductibles(As per policy T & C) 1,000.00 Dealer GSTIN : 24AABCR7938L1ZY Net Bill Amount (Rounded) 12,257.00 Rupees Twelve Thousand Two Hundred And Fifty Seven 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. : GP20005653 Date : 29-SEP-20 11:44:47 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : New Dzire Petrol JC20004780 BI/20000660 29-SEP-20 12,257.00 Tech.Name :MAHENDRA ASHOKBHAI BELD Reg.No.: GJ16CH5823 JC20004780 BR/20002786 29-SEP-20 1,234.00 Customer Signature Accountant Signature JC20004780 ---PAGE END---