ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID :02-39 Invoice No. : 4/BI/20001436 Date : 28/01/2021 Bajaj Allianz General Insurance Co. Ltd, 4TH FLOOR, HALWASIYA COMM, HOUSE, HABIBULLAH Job Card No.: JC20010377 Job Card Date : 20/01/2021 ESTATE, 11 MG MARG, HAZRATGANJ, Reg.No. : UP27Y8524 Mileage : 46388 LUCKNOW SA Name : MOHD ARSHAD Pin:226001 Model : MARUTI CELERIO VXI EW Contract No. : 144362405 State & Code : 09-UTTAR PRADESH Chassis No.: 143385 TV Certificate No. : C17001385511 Mobile Fuel Trim : Service type : BODY REPAIR Loyalty Card : NA BAJAJ Place of Supply : UTTAR PRADESH Ins.Comp. Cust GSTIN/UIN : 09AABCB5730G1ZV 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% 6.000 2.54 15.24 2 03241M0516A SCREW AB 7318 18% 6.000 1.69 10.14 3 09409M07L01 CLIP AB 8708 28% 12.000 3.12 37.44 4 09409M08006 CLIP AB 8708 28% 12.000 3.12 37.44 5 35321M76M00 .HEAD LAMP UNIT LH AA 8512 18% 1.000 1757.62 1757.62 6 71411M76M00 COVER,FR BUMPER LWR AA 8708 28% 1.000 156.25 156.25 7 71711M76M00-5PK FR BUMPER W/O FOG LAMP AA 8708 28% 1.000 1015.62 1015.62 (CELERIO) 8 71731M76M00 HOLDER,FR BUMPER SIDE,R AC 8708 28% 1.000 52.34 52.34 9 71732M76M00 HOLDER,FR BUMPER SIDE,L AA 8708 28% 1.000 46.87 46.87 10 72322M76M01 LINING,FRONT FENDER,L AC 8708 28% 1.000 210.93 210.93 11 77821M79M00-A1D EMBLEM, MARUTI SUZUKI (CHROME) AA 8708 28% 1.000 105.46 105.46 12 990J0M999H2-250 SCREEN WASH 50ML AB 3402 18% 4.000 14.40 57.60 13 990J0M999H2-300 ECSTAR CAR WASH SHAMPOO AA 3402 18% 0.200 319.49 63.90 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF9992 DENTING CHARGES 998729 300.00 2 ZF27P0 FRONT BUMPER PAINTING 998729 2,530.00 Sub Total Amount 3,566.85 2,830.00 bajaj allianz , mr. d.k. katiyaar CGST @ 14% 232.73 SGST @ 14% 232.73 CGST @ 9% 171.40 254.70 SGST @ 9% 171.40 254.70 For SUMITRA DS MOTORS PVT. LTD. Tax Collection at Source @ 0.075% 3.29 Sub Total Amount : 4,378.40 3,339.40 Authorised Signatory Net Bill Amount (Rounded) 7,718.00 Dealer GSTIN : 09AAICS2580E1Z9 Rupees Seven Thousand Seven Hundred And Eighteen 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 (Customer Signature) Mobile No.: to inform me with any other information in relation to my vehicle. Gate Pass GP No. : GP20010316 Date : 28-JAN-21 09:50:39 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance C Model : CELERIO JC20010377 BI/20001436 28-JAN-21 7,718.00 Tech. Name :SACHIN SHUKLA Reg No.: UP27Y8524 JC20010377 BR/20002965 28-JAN-21 0.00 Customer Signature Accountant Signature ---PAGE END---