ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER Job Card Retail - Tax Invoice IRN : adf137b84174dffc2576a4ed6834469200d94a43f89924b7ccde0160617f8500 Customer Name & Address : ID :02-39 Invoice No. : 1/BI/20001699 Date : 18/03/2021 14:21:20 Bajaj Allianz General Insurance Co. Ltd, 4TH FLOOR, HALWASIYA COMM, HOUSE, HABIBULLAH Job Card No.: JC20009052 Job Card Date: 14/03/2021 ESTATE, 11 MG MARG, HAZRATGANJ, Reg.No. : UP32JP0142 Mileage : 24062 LUCKNOW SA Name : WARIS CHISHTY SA(M) : 9628374837 Pin:226001 State & Code :09-UTTAR PRADESH Model : ALTO K10 VXI EW Type : III Mobile : Chassis No.: 401370 Last Service : 10211 (23-02-19) Loyalty Card : 33038758992 Fuel Trim : Next Service Due : PMS 20 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 68003M53M00 PANEL ASSY,REAR DOOR,R AC 8708 28% 1.000 6183.59 6183.59 0.00 Labour Demanded Repairs-Others/Suggested Jobs 1 ZF9993 PAINTING CHARGES 998729 3,770.00 2 ZF9992 DENTING CHARGES 998729 400.00 Sub Total Amount 6,183.59 0.00 4,170.00 NONMI-BAJAJ SURV- NAVDEEP THAKUR CGST @ 14% 865.70 SGST @ 14% 865.70 CGST @ 9% 375.30 SGST @ 9% 375.30 For BRIGHT 4 WHEEL SALES PVT. LTD. Sub Total Amount 7,914.99 0.00 4,920.60 Authorised Signatory Deductibles(As per policy T & C) 1,000.00 Dealer GSTIN :09AACCB8810E1ZV Net Bill Amount (Rounded) 11,836.00 Rupees Eleven Thousand Eight Hundred And Thirty Six 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. : GP20008799 Date : 18-MAR-21 14:22:07 Job Card No. Bill.No. Bill Date Amount Cust. Name : Bajaj Allianz General Insurance Co. L Model : ALTO K10 JC20009052 BR/20004086 18-MAR-21 1,000.00 Tech. Name :ASIFUDDAULA ASIFUDDAULA Reg.No.: UP32JP0142 JC20009052 BI/20001699 18-MAR-21 11,836.00 Customer Signature Accountant Signature JC20009052 ---PAGE END---