ORIGINAL FOR RECIPIENT/DUPLICATE FOR TRANSPORTER/TRIPLICATE FOR SUPPLIER

Job Card Retail - Tax Invoice

Customer Name & Address : ID : 33-19 Invoice No. : 1/BI/21000003 Date : 26/03/2022 18:53:15
Go Digit General Insurance Limited
D R Brijmohan Building,, 4th Floor, Opp, Rajiv, Bhavan ABC, GS Job Card No. : JC21003580 Job Card Date: 26/03/2022
Road,
Reg.No. : AS32A0601 Mileage : 3911
GUWAHATI
Pin:781005 SA Name : DIPJYOTI SARMAH SA(M) : 9957075630
State & Code : 18-ASSAM Model : MARUTI VITARA BREZZA Z EW Type : III
Mobile : 8956298908 Chassis No. : 887849 Last Service : 1063 (11-02-22)
Next Service Due : 2ND FREE SERVICE
Loyalty Card : NA Fuel Trim : Service type: BODY REPAIR
Cust GSTIN/UIN : 18AACCO4128Q1ZZ Place of Supply: ASSAM
Ins.Comp. : GO DIGIT GIC
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 84055M85S00 GLASS SET,WINDSHIELD AB 70072190 18% 1.000 4449.15 4449.15 0.00
2 84611M82P01 MOLDINGWINDSHIELD AA 87089900 28% 1.000 304.68 304.68 0.00
3 99000M24120-460 DG SEALANT SET WITHOUT PRIMER AD 35069999 18% 2.000 614.40 1228.80 0.00
Labour
Demanded Repairs-Others/Suggested Jobs
1 ZA67L0 GLASS ETCHING 998729 1,500.00

Sub Total Amount : 5,982.63 0.00 1,500.00

done
CGST @ 14% : 42.66
SGST @ 14% : 42.66
CGST @ 9% : 511.01 135.00
SGST @ 9% : 511.01 135.00
For BINA AUTOMATION Tax Collection at Source : 7.09

Authorised Signatory Sub Total Amount : 7,097.06 0.00 1,770.00

Dealer GSTIN : 18AZPPS2981L1ZD Net Bill Amount (Rounded) : 8,867.00
Rupees Eight Thousand Eight Hundred And Sixty Seven Only
* This is a system generated soft copy of invoice for insurance company records.

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
inform me with any other information in relation to my vehicle.
Mobile No.:

Gate Pass
GP No. : GP21003564 Date : 26-MAR-22 18:53:37 Job Card No. Bill.No. Bill Date Amount
Cust. Name : Go Digit General Insurance Limited Model : VITARA BREZZA K15B BS-VI JC21003580 BC/21003565 26-MAR-22 0.00
Tech. Name : MUBARAK ALI Reg.No. : AS32A0601 JC21003580 BI/21000003 26-MAR-22 8,867.00

Customer Signature
Accountant Signature

Created By: RUPJYOTI SARMAH