TAX INVOICE Issued under GST Invoice Rules Original : For Recipient Duplicate : For Supplier BAJAJ ALLIANZ GENERAL INSURANCE Invoice No : AY2021/198 ModeI:TATA TIAGO COMPANY Invoice Date : 21/01/2021 Chassis No:MAT626289JKNA8846 3 RD FLOOR SHAHNAJAF ROAD NARAYAN Service Request Type : Accident Vehicle Regn.No:JH02AW9083 BULDING HAZRATGANJ, Job Card No. : JC-AyushM-AY-2021-002566 LUCKNOW Job Card Date : 13/01/2021 LUCKNOW Kms:32633 LUCKNOW Dealer Name:AYUSH MOTORS (India) Pvt. UP, 226010 Ltd. India Dealer GSTIN :09AAGCA1314E1Z7 Customer GSTIN : 09AABCB5730G1ZV Place of Supply : Uttar Pradesh Total Extr| CGST SGST/UTGST Part #/Job Qt Amt DiscLiablitTaxable Descriptio [Billingg|UO Disc/It S No HSN/SAC Rate % Total Amt Code n TypeM y (Base Chr em y % Amt Rate Amt Rate Amt Price) g % FITMENT CHARGES (ACCIDEN TAL LABOR CHARGES) Insura 4,90 1 998714 OTFIT (AMIT 0.00 0 0.00 100 4,900.00 9.00 441.00 9.00 441.00 5,782.00 nce 0.00 CHAMBIAL 844778785 1)CLAIM N- OC211103 187000033 97) FRONT 2332.031 542488506 InsuraEac 2 8708.99.00 BUMPER [2,332.03 0.00 100 2,332.03 14.00 326.48 14.00 326.48 2,985.00 353 nce h 25 SKIN SPLASH 542488506 GUARD InsuraEac 3 8708.10.90 531.25 531.25 0.00 100 531.25 14.00 74.38 14.00 74.38 680.00 317 FRONT nce h BUMPER ADD ON PART, 542488500 InsuraEac 4 8708.99.00 FRONT 540.62 540.625 0.00 100 540.62 14.00 75.69 14.00 75.69 692.00 134 nce h BUMPER, LH FRONT 542488506 InsuraEac 5 8708.99.00 BUMPER [3,509.38[3509.375 0.00 100 3,509.38 14.00 491.31 14.00 491.31 4,492.00 360 nce h GRILL FRONT 542488506 InsuraEac 6 8708.99.00 BUMPER 1[3,393.753393.75 0.00 100 3,393.75 14.00 475.12 14.00 475.12 4,344.00 357 nce h GRILL 570750100[RADIATOR[InsuraEac 7 8708.99.00 h 1 4,021.884021.875 0.00 100 4,021.88 14.00 563.06 14.00 563.06 5,148.00 120 ASSY nce LAMP H4 12V60/55W G62120601 InsuraEac| 134.7457 8 8512.20.10 P43T-38 E. 134.75 0.00 100 134.75 9.00 12.13 9.00 12.13 159.00 011 nce h 6 CERT. ECE.R37 LAMP P21/5 12V 621206014 21/5W InsuraEac 9 8539.21.20 62.71 62.71186 0.00 100 62.71 9.00 5.64 9.00 5.64 74.00 02N BAY15D E nce h CERT. ---PAGE END--- ACGASR13AC GAS InsuraGra60 9.00 10 2903.11.10 1.69 1016.952 0.00 100 1,016.95 91.53 9.00 91.53 1,200.00 4 R134A nce m 0 InsuraEac 9.00 11 7318.15.00 FSTCLP02 CLIP 2 16.95 33.8983 0.00 100 33.90 9.00 3.05 3.05 40.00 nce h HEAD 542454400 InsuraEac 3521.186 12 8512.20.10 LAMP [3,521.19 0.00 100 3,521.19 9.00 316.91 9.00 316.91 4,155.00 101 nce h 44 ASSY, LH Parts Net Taxable Amount: 19,098.40 Labour Net Taxable Amount: 4,900.00 Final Parts Invoice Amount: 23,969.00 Final Amount on Labour: 5,782.00 @9% CGST on Parts:429.25 @ 9% CGST on Labour:441.00 @14% CGST on Parts:2,006.05 @ 9% SGST on Labour:441.00 @9% SGST on Parts:429.25 @14% SGST on Parts:2,006.05 Sub Total: 23,998.40 Total Tax: 5,752.60 Gross Amount: 29,751.00 Adjustment Amount: -0.00 Rupees Twenty Nine Thousand Seven Hundred Fifty One Only. Grand Total : 29,751.00 Tax Payable under Reverse Charge - No Terms and Conditions: E. & 0. E 1) Goods once sold will not be taken back . 2) Only the courts of BANGALORE shall have jurisdiction in any proceedings relating to this contract. Vehicle / Goods received in good condition and to our satisfaction. For AYUSH MOTORS (India) Pvt. Ltd. ---PAGE END---