ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice IRN : 34d66dc801bfc14af8966143953682662ea9ff4625cca60fa1666a861f203f6f Customer Name & Address : ID:02-39 Invoice No. : 1/BI/20001397 Date : 31/01/2021 16:07:55 Bajaj Allianz General Insurance Co. Ltd, 4TH FLOOR, HALWASIYA COMM, HOUSE, HABIBULLAH Job Card No.: JC20006455 Job Card Date: 22/12/2020 ESTATE, 11 MG MARG, HAZRATGANJ, Reg.No. : UP41Q3400 Mileage: 80891 LUCKNOW SA Name : WARIS CHISHTY SA(M) : 9628374837 Pin:226001 State & Code :09-UTTAR PRADESH Model : MARUTI SWIFT VDI EW Type : NA Mobile : Chassis No.: 128646 Last Service : 39260 (03-03-14) Loyalty Card : NA Fuel Trim : Next Service Due : PMS 50 Service type: BODY REPAIR Cust GSTIN/UIN : 09AABCB5730G1ZV PAN : AABCB5730G 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 35121M74L01 UNIT, HEADLAMP RH AC 8512 18% 1.000 2080.50 2080.50 0.00 2 38500M55R00 HORN ASSY, LOW PITCHED AC 8512 18% 1.000 275.42 275.42 0.00 3 41601M74L51 STRUT ASSY,FRONT SPNSN,R AC 8708 28% 1.000 1453.12 1453.12 0.00 4 41710M74L00 SUPPORT, FRONT STRUT AC 8708 28% 1.000 312.50 312.50 0.00 5 42420M55K02 JOINT COMP,FR STABILIZER BAR AC 8708 28% 1.000 378.90 378.90 0.00 6 43110M75J80 165/80R14 DURAPLUS (GY) 4011 28% 1.000 2805.46 2805.46 0.00 7 43210M74L02-09L WHEEL COMP(14X5J) AD 8708 28% 1.000 796.87 796.87 0.00 8 44101M74L82 SHAFT ASSY,FRONT DRIVE,R AC 8708 28% 1.000 4890.62 4890.62 0.00 9 45201M74L20 ARM ASSY,FRONT SUSPENSION,R AC 8708 28% 1.000 1789.06 1789.06 0.00 10 45810M60M00 FRAME, FRONT SUSPENSION AC 8708 28% 1.000 5953.12 5953.12 0.00 11 48500M74L04 BOX ASSY, STEERING GEAR AB 8708 28% 1.000 6898.43 6898.43 0.00 12 57611M71P10 PANEL,FRONT FENDER,R AC 8708 28% 1.000 1039.06 1039.06 0.00 13 68001M74L20 PANEL ASSY,FR DOOR,R AC 8708 28% 1.000 3085.93 3085.93 0.00 14 71711M83P00-5PK BUMPER, FRONT (BLACK) AC 8708 28% 1.000 1437.50 1437.50 0.00 ---PAGE END--- ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice Customer Name & Address : ID : 02-39 Invoice No. : 1/BI/20001397 Date : 31/01/2021 16:07:55 Bajaj Allianz General Insurance Co. Ltd, 4TH FLOOR, HALWASIYA COMM, HOUSE, HABIBULLAH Job Card No.: JC20006455 Job Card Date: 22/12/2020 ESTATE, 11 MG MARG, HAZRATGANJ, Reg.No. : UP41Q3400 Mileage: 80891 LUCKNOW SA Name : WARIS CHISHTY SA(M) : 9628374837 Pin:226001 State & Code :09-UTTAR PRADESH Model : MARUTI SWIFT VDI EW Type : NA Mobile Chassis No.: 128646 Last Service : 39260 (03-03-14) Fuel Trim : Next Service Due : PMS 50 Loyalty Card : NA Service type: BODY REPAIR Cust GSTIN/UIN : 09AABCB5730G1ZV PAN : AABCB5730G 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 16 71741M83P00-5PK GRILLE, RADIATOR UPPER (BLACK) AC 8708 28% 1.000 250.00 250.00 0.00 17 72321M74L10 LINING, FRONT FENDER RH AC 8708 28% 1.000 386.71 386.71 0.00 18 72460M74L00 COVER COMP,FR BUMPER LOWER AC 8708 28% 1.000 167.96 167.96 0.00 19 83921M74L00-0CB TAPE, FRONT DOOR OUTER FR RH AB 3919 28% 1.000 171.87 171.87 0.00 20 83923M74L00-0CB TAPE, FRONT DOOR OUTER RR RH AA 3919 28% 1.000 140.62 140.62 0.00 21 84730M74LC0 .GLASS, OUT REAR VIEW RH AC 7009 28% 1.000 207.03 207.03 0.00 22 89910M74L00 JACK ASSY AB 8708 28% 1.000 460.93 460.93 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF9992 DENTING CHARGES 998729 3,300.00 2 ZF9993 PAINTING CHARGES 998729 15,380.00 Sub Total Amount 35,208.17 0.00 18,680.00 NONMI/BAJAJ ALLIANZ SURV R.S PANDEY CGST @ 14% 4,599.32 SGST @ 14% 4,599.32 CGST @ 9% 212.04 1,681.20 SGST @ 9% : 212.04 1,681.20 For BRIGHT 4 WHEEL SALES PVT. LTD. Sub Total Amount : 44,830.89 0.00 22,042.40 Authorised Signatory Deductibles(As per policy T & C) 1,000.00 Dealer GSTIN :09AACCB8810E1ZV Net Bill Amount (Rounded) 65,873.00 Rupees Sixty Five Thousand Eight Hundred And Seventy Three 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. : GP20007352 Date : 31-JAN-21 16:09:18 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : SWIFT NEW/ DZIRE NEW DIESEL JC20006455 BR/20003412 31-JAN-21 4,029.00 Tech. Name :ASIFUDDAULA ASIFUDDAULA Reg.No.: UP41Q3400 JC20006455 BI/20001397 31-JAN-21 65,873.00 Customer Signature Accountant Signature JC20006455 ---PAGE END---