ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID:02-39 Invoice No. : 032/BI/20000703 Date : 14/09/2020 15:36:30 Bajaj Allianz General Insurance Co. Ltd, 4TH FLOOR, HALWASIYA COMM, HOUSE, HABIBULLAH Job Card No.: JC20003374 Job Card Date: 03/09/2020 ESTATE, 11 MG MARG, HAZRATGANJ, Reg.No. : MH04HF3706 Mileage: 54518 LUCKNOW SA Name : ABHISHEK TRIPATHI SA(M) : 7705801195 Pin:226001 State & Code :09-UTTAR PRADESH Model : MARUTI S-CROSS ZETA EW Type : NA Mobile Chassis No.: 123406 Last Service : 49615 (31-01-20) Loyalty Card : 77000044509 Fuel Trim : Next Service Due : PMS 50 Service type: BODY REPAIR Cust GSTIN/UIN : 09AABCB5730G1ZV 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 01550M0616A BOLT AB 7318 18% 10.000 2.54 25.40 0.00 2 03141M05165 .SCREW AB 7318 18% 10.000 2.54 25.40 0.00 3 09409M08L01 CLIP AB 8708 28% 10.000 3.12 31.20 0.00 4 71711M64M00-5PK BUMPER,FR UPR(BLACK) AC 8708 28% 1.000 1750.00 1750.00 0.00 5 71740M64MA0-C48 GRILLE COMP,RADIATOR UPPER AC 8708 28% 1.000 2617.18 2617.18 0.00 6 77210M64M00-5PK GUARD ASSY,FR FENDER SPLASH,R AD 8708 28% 1.000 246.09 246.09 0.00 7 99000M24121-136 PAPER FLOOR MAT (20X15) AB 4820 18% 5.000 0.84 4.20 0.00 8 990J0M999H2-130 BDY G.MOP MICROFBR FINSH CLTH 4 AA 6307 5% 0.500 487.61 243.81 0.00 PCK Labour Demanded Repairs-Others/Suggested Jobs 1 ZF9993 PAINTING CHARGES 998729 9,600.00 2 ZF9992 DENTING CHARGES 998729 1,000.00 Sub Total Amount 4,943.28 0.00 10,600.00 NON-MI CGST @ 14% : 650.23 SGST @ 14% : 650.23 CGST @ 9% 4.96 954.00 SGST @ 9% 4.96 954.00 For SMART WHEELS PVT LTD. CGST @ 2.5% : 6.10 SGST @ 2.5% : 6.10 Authorised Signatory Dealer GSTIN : 09AACCR1862L1Z2 Sub Total Amount 6,265.86 0.00 12,508.00 Net Bill Amount (Rounded) 18,774.00 Rupees Eighteen Thousand Seven Hundred And Seventy Four 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. : GP20003368 Date :14-SEP-20 15:36:48 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : S-CROSS (D13) JC20003374 BR/20001400 14-SEP-20 2,726.00 Tech. Name :FIROJ ALAM Reg.No.: MH04HF3706 JC20003374 BI/20000703 14-SEP-20 18,774.00 Customer Signature Accountant Signature JC20003374 ---PAGE END---