TAX INVOICE Issued under GST Invoice Rules Original :For Recipient Duplicate :For Supplier BAJAJ ALLIANZ GENERAL INSURANCE CO LTD Invoice No : IVNKHY2021004373 4TH FLOOR.NORTH EAST PLAZA, ERRAMANZIL CIRCLE, BESIDE Invoice Date :23/12/2020 BMW S/R Model : TATA TIAGO GSTIN: 36AABCB5730G1ZY Chassis No : MAT626350LKN46415 SECUNDERABAD, HYDERABAD Insurance Co : BAJAJ ALLIANZ GENERAL INSURANCE HYDERABAD, 500082 CO.LTD Telangana(36) Insurance Type : Phone No (Res,Off,Mob): , , 9100021944 Insurance Expiry Date : Customer GSTIN : Kms. : 1079 A/C Code : 1-1UY7ZZ63 Vehicle Regn. No : TS06FB7524 Place of Supply: 36-Telangana Job Card No. : JC-VkmMot-HP1-2021-004086 Job Card Date : 17/12/2020 Service Request Type : Accident Customer P.O. No - Date : Payment Method : CASH Warranty Expired :N Dealer PAN:AAMFV5051C Dealer GSTIN : 36AAMFV5051C1Z7 PAN : Total Insuran SGST/UTGS Disc Campai CGST Total Amt s Part#/Job Amt Extra ce Taxabl T HSN/SAC Particulars Type UoM Qty Rate Amt/Itegn Disc Disc % (Incl. No Code (Base Chg Liabilitye AmtRateAmounRateAmoun Taxes) m % % % Price) t % t ASSY 8512.20.15427544001|FFRONT 1 Paid Each 1 950.00 950.00 0 950.00 9 85.50 9 85.50 1,121.00 0 23 FOG LAMP W/O DRL FRONT 8708.99.05424885063 2,150. 2,150.7 2 BUMPER Paid Each 1 [2, 150.78 0 14 301.11 14 301.11 2,753.00 0 26 SKIN 78 8 CHROME 8708.99.05424885063 1,567. [1,567.1 3 STRIP,TOP Paid Each 1 1,567.19 0 14 219.41 14 219.41 2,006.00 0 31 19 9 GRILL FOG LAMP 8708.99.0 5424885001 4 BEZEL Paid Each 1 245.31 245.31 0 245.31 14 34.34 14 34.34 314.00 0 45 ASSY,LH 8512.20.15424544001HEADLAMP 3,021.] 3,021.1 5 Paid Each 1 3,021.19 0 9 271.91 9 271.91 3,565.00 0 39 ASSY,LH 19 9 CHROME 8708.99.05424885063STRIP,TOP 6 Paid Each 1 690.62 690.62 0 690.62 14 96.69 14 96.69 884.00 0 32 GRILL, UPPER-LH SHEET METAL WELDING/R EPAIR/PAIN|INSURAN 7 998714 980016 1 0 0 500 0.00 0 500.00 9 45.00 9 45.00 590.00 TINGHEAD CE LIGHT PANNEL REPAIR SHEET METAL WELDING/R INSURAN 8 998714 980016 EPAIR/PAIN 0 0 75 0.00 0 75.00 9 6.75 9 6.75 88.50 CE TINGLH HEAD LIGHT R/R SHEET INSURAN 9 998714 980016 METAL 1 0 o 500 0.00 0 500.00 9 45.00 9 45.00 590.00 ---PAGE END--- = 5 a : 3 3 = 0 : : : : : : : : + 4 : : E : : : : 9 9 4E1 1H1E41H3 1 I111111 E HEI1EEE 1 1133: EE17131 1 1313 :3 1 E11 3 3 3 3 : : RE RE RE RE RE RE RE RE : = - - - = - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 :: 2 : : : : E : : : : : :: : : : : E 000E :0 :0 060E :0 00 Of0E :0 1E : : : : : 8 6 6 6 6 6 6 6 0 % 1 6 E 0 1 : : : : : : 6 6 6 6 6 8 6 6 E 0 1 E 1 : E 1 E E: : 8 8 : =: : : : : : : ---PAGE END--- @ 9% SGST on Labour: 1385.10 @ 9% CGST on Parts: 357.41 @ 9% SGST on Parts: 357.41 @ 14% CGST on Parts: 651.55 @ 14% SGST on Parts: 651.55 Gross Amount : 28,803.20 Adjustments : -0.20 Rupees Twenty Eight Thousand Eight Hundred Three Only. Grand Total : 28,803.00 Note: 1) Insurance Liability % will only come for Insurance Job cards. Tax Payable under Reverse Charge -- No Special Observations : Terms and Conditions : E. &O.E. 1) Goods once sold will not be taken back or exchanged except as required by law. 2) Only the courts of HYDERABAD shall have jurisdiction in any proceedings relating to this contract. 3) I have inspected the vehicle TS06FB7524 and taken delivery.of the vehicle only after being satisfied regarding the maintenance work carried out in the vehicle. I do not have any grievances/complaints pertaining to the chassis no MAT626350LKN46415 4) I hereby consent and authorize VENKATARAMANA MOTORS - 3008780 / HYDERABAD and Tata Motors Limited for usage of all the data disclosed above and also to share all my details and documents for promotional, marketing and transactional activities of Tata Motors Ltd. or any of its group companies/subsidiaries/ authorized dealers, in accordance with Tata Motor's Privacy Policy. I shall inform in writing to Tata Motors Limited, if I intend to withdraw my aforesaid consent. For VENKATARAMANA MOTORS - 3008780 Customer's Signature Authorized signatory ---PAGE END--- VENKATARAMANA MOTORS - 3008780 * GATEPASS * Customer Name : BAJAJ ALLIANZ GENERAL INSURANCE CO LTD Invoice Ref. : IVNKHY2021004373 dated 23/12/2020 Vehicle No : TS06FB7524 Invoice Amount : Rs. 28,803.00 Chassis No : MAT626350LKN46415 Job Card / Order ref : JC-VkmMot-HP1-2021-004086 dated 17/12/2020 Model Name : TATA TIAGO Gate Pass No & Date : Vehicle / Goods received in good condition and to our satisfaction. ---PAGE END---