BAJAJ                       JAY DWARKADHISH MOTORS
                 Distetig Akead        RAJKOT JAMNAGAR HIGHWAY OPP.MELDI MATA MANDIRHAPA, JAMNAGAR,
        GSTIN No. : 24AAJFJ1446Q1ZZ                                          Tax Invoice    Debit Memo       ORIGINAL
        PAN No.:AAJFJ1446QStateGujaratState Code :24
        Invoice No.  SP2378
        Invoice Date 15/12/2020Details of Receiver (Billed to)                 Details of Consignee(Shipped to)
       Name       1BAJAJ ALLIANCE GENERAL INSURANCE COMPANY LTD   NameAddress: BAJAJ ALLIANCE GENERAL INSURANCE COMPAI:1ST FLOORHOTEL K ROSE BUILDING
       Address    1ST FLOOR,HOTEL K ROSE BUILDINGLIMBDA CHOCK,RAJKOT          LIMBDA CHOCK,RAJKOT
                   RAJKOT               State Code :24            State       RAJKOT               State,Code
       StateGSTIN No.24AABCB5730G1Z3Gujarat                       GSTIN No.  :Gujarat24AABCB5730G1Z3       24
       PAN No.Sr.  AABCB5730G                  HSNISAC        Qty|PAN No.RateDiscountAABCB5730G[GST%SGSTCGST    Amount
              Part No, Description of Goods
           1 BH184000  GLASS GREEN WINDSHLDONE PIECEFL700721901.000 3372.88          18.00    303.56   303.56    3980.00
           2 52AZ0176  ED COATED SIDE DOOR LH  87149990      1.000  2125.00          28.00    297.50   297.50    2720.00
           34AZ213126.AZ211093HOOD ASSLY YELLOWASSLY HOOD FRAME UG87081090870829001.0001.0002620.31781.2528.0028.00366.84109.38366.84109.383354.001000.00
           5 BODY WOR  BODY WORK                998729       1.000  2711.86          18.00   244.07213.56244.07213.563199.99
           67PAINTR@R  PAINT WORKR@R.CHARGES   998729998729  1.0001.0002372.881694.9218.0018.00152.54  152.54    2800.002000.01
        GST Summary       Amount      Sub TotalSGSTCGST7.000   Total                         1687.45  1687.45   19053.99
       Sales 12%Sales 5%
       Sales 28%Sales 18%10152.545526.56913.73   913.73-773.7211980.007074.00
       Sales 0%                       773.72
       Total             15679.10    1687.45     1687.45    19054.00                              Invoice Total 1.9054.00
        GJ10TW5238 CLAIM NO -OC-21-2204-1803-00000331Invoice Value (In Words) :Nineteen Thousand Fifty Four Only
        TERM & CONDITIONSubject to HAPA jurisdiction.                                     For, JAY DWARKISONOy   TORS
                                                                                                      AlthorisSiggatory
        E.&O.E.                                                                Certifed that the particulars given Sgrue and correct