SURVEY NO.170 TODI, SITAMAU FATAX, MANDSAUR Pin:458001 Job Card Retail -Tax Invoice Date : 16/03/2021 18:19:55 Customer Name&Address ID02-04 Invoice No. :1/Bl/20000016 Bajaj Allian General Insurance Co.Ltd, Job Card Date: 16/03/2021 4th floor, Commerce House,7 Race Course Road 1Job Card No.:JC20003101 Mileage:14511 INDORE Reg.No.DMY8109030 Pin:452001 SA Name : DHARMENDRA SINGH CHOUHAN SA(M) :9617223430 State &Code 23-MADHYA PRADESH Model :BURGMAN STREET UB12! EW Type :NA Last Service : 3363 (23-08-19) Mobile Next Service Due :2nd Paid Service Loyalty Card Chassis No.: MB8EA11AGJ8109030 NA Cust GSTIN/UIN 23AABCB5730G1Z5 Service type: ACCIDENTAL REPAIR Ins.Comp.BAJAJ Place of Supply:MADHYA PRADESH Surveyor Name : Labour Taxable Tax Paid Qty. Rate Charges Srl. Part Number HSNISAC Tax Amount Amount Description Parts Demanded Repairs-Others/Suggested Jobs 5022.03 0.00 1.000 5022.03 18% 0.00 1 35100-44K00-000 85122010 1175.78 1175.78 HEADLAMP ASSY 28% 1.000 2 46211-44K00-YVB 87149390 295.31 0.00 HANDLE, PILLION RIDER (BLACK) 28% 1.000 295.31 3 47311-44K00-YVB 87141090 1178.12 0.00 COVER,FRAME CENTER (BLACK) 28% 1.000 1178.12 4 48111-08K00-PGZ 87141090 521.87 0.00 SHIELD,LEG FRONT(GRAY) 28% 1.000 521.87 5 48132-44K00-YVB 87141090 0.00 SHIELD, LEG RR SIDE RH (BLACK) 1.000 521.87 521.87 87141090 28% 6 48133-44K00-YVB SHIELD,LEG RR SIDE LH (BLACK) 625.78 625.78 0.00 87141090 28% 1.000 7 48211-44K00-YVB SHIELD, LEG FRONT,RH (BLACK) 625.78 0.00 28% 1.000 625.78 8 48221-44K00-YVB 87141090 SHIELD,LEG FRONT,LH (BLACK) 1689.06 0.00 28% 2.000 844.53 9 51110-08K00-000 TUBE,INNER 87149100 1862.50 1862.50 0.00 87141090 28% 1.000 10 51410-08K10-000 BRACKET.UNDER 805.46 805.46 0.00 11 87141090 28% 1.000 53111-44K00-YPA FENDER, FRONT (WHITE) 0.00 28% 1.000 63.28 63.28 12 57421-39J60-000 LEVER,BRAKE RH 87141090 28% 1.000 70.31 70.31 0.00 13 68641-33GC0-000 EMBLEM.(S) 87089900 14 28% 1.000 63.28 63.28 0.00 92112-44K00-000 RACK,LEG SHIELD 87141090 15 94671-44K0-000 PANEL,FRONT 87141090 28% 1.000 49.21 49.21 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 HE9999 OTHER 998729 1,500.00 Sub Total Amount 14,569.64 0.00 500.00 ok CGST @ 14% 1,336.66 SGST @ 14% 1,336.66 CGST @ 9% 451.98 135.00 SGST @ 9% 451.98 135.00 For TIRTHANKAR AUTOMOBILES LLP Sub Total Amount 18,146.92 0.00 1.770.00 Authorised Signatory Net Bill Amount (Rounded) 19,917.00 Dealer GSTIN:23AALFT9956H1ZL Rupees Nineteen Thousand Nine Hundred And Seventeen 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. 4 Gate Pass GP No. GP20003080 Date:16-MAR-21 18:20:44 Job Card No.EBill.No. Bill Date Amourr Cust. NameBajaj Allianz General Insurance Co. Model New Ser Variant-UB125 JC20003101 BI/20000016 16-MAR-21 197.00 Tech.Name:RAMESH MALVIYA Reg.No.:DMY8109030 Customer Signature Accountant Signature JC20003101 Created By: MANAGER. ---PAGE END---