Tax Invoice (ORIGINAL FOR RECIPIENT) e-Invoice

IRN : 876ea3c2def7a74fe15c983247bded8247a24-
26db961dada8ed2556bb1f314c8
Ack No. : 152211896634356
Ack Date : 4-Apr-22

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com Dispatch Doc No. Delivery Note Date

Consignee (Ship to) Dispatched through Destination

The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
Terms of Delivery
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37

Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

1 PFC SIGMA C/R NPOR FEM LT SZ 3 90213100 960003 1 No 22,667.00 No 22,667.00

Batch : D19012575 1 No
Expiry : 31-Dec-23
LM:M/s DePuy Orthopaedics Inc., US
DC:892
2 SIGMA CRVD GVF INS SIZE2.5 10MM 90213100 158112010 1 No 9,664.00 No 9,664.00

Batch : D21100515 1 No
Expiry : 30-Sep-26
LM:M/s DePuy Orthopaedics Inc., US
DC:1273
3 PFC MOD TIB TRAY CEM SZ 2.5 90213100 866029 1 No 16,600.00 No 16,600.00
Batch : D21084215 1 No
Expiry : 31-Aug-31
LM:DePuy Orthopaedics Inc., US
DC:1388
4 Smartset GHV Gentamicin 40G 30064000 3095040 1 No 0.01 No 0.01
Batch : 9880605 1 No
Expiry : 31-Aug-23
LM:DePuy Orthopaedics Inc., US
DC:1420
48,931.01
IGST 2,446.55

continued to page number 2

SUBJECT TO CHENNAI JURISDICTION
This is a Computer Generated Invoice
 Tax Invoice(Page 2) (ORIGINAL FOR RECIPIENT)

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com
Dispatch Doc No. Delivery Note Date
Consignee (Ship to)
The Director ( BIRRD) Dispatched through Destination
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI Terms of Delivery
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

ROUND OFF 0.44

PATIENT NAME : P.VIRAMARAPPA
AGE : 59/M
DOCTOR NAME : DR.SANDEEP KRISHNA
IP NO : UMR10841
DATE OF IMPLANT : 2-Mar-22
(TKR/L)

Total 4 No 51,378.00
Amount Chargeable (in words) E. & O.E
INR Fifty One Thousand Three Hundred Seventy Eight Only
HSN/SAC Taxable Integrated Tax Total
Value Rate Amount Tax Amount

90213100 48,931.00 5% 2,446.55 2,446.55

30064000 0.01 5%
Total 48,931.01 2,446.55 2,446.55

Tax Amount (in words) : INR Two Thousand Four Hundred Forty Six and Fifty Five paise Only
Company’s PAN : AEVPD3749L
Declaration Company’s Bank Details
Bank Name : UNION BANK OF INDIA
We declare that this invoice shows the actual price of the A/c No. : 611701010050545
goods described and that all particulars are true and correct. Branch & IFS Code : WEST MAMBALAM & UBIN0561177

Customer’s Seal and Signature for SRI SAI AGENCIES

Authorised Signatory

SUBJECT TO CHENNAI JURISDICTION

This is a Computer Generated Invoice
 Tax Invoice (DUPLICATE FOR TRANSPORTER) e-Invoice

IRN : 876ea3c2def7a74fe15c983247bded8247a24-
26db961dada8ed2556bb1f314c8
Ack No. : 152211896634356
Ack Date : 4-Apr-22

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com Dispatch Doc No. Delivery Note Date

Consignee (Ship to) Dispatched through Destination

The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
Terms of Delivery
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37

Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

1 PFC SIGMA C/R NPOR FEM LT SZ 3 90213100 960003 1 No 22,667.00 No 22,667.00

Batch : D19012575 1 No
Expiry : 31-Dec-23
LM:M/s DePuy Orthopaedics Inc., US
DC:892
2 SIGMA CRVD GVF INS SIZE2.5 10MM 90213100 158112010 1 No 9,664.00 No 9,664.00

Batch : D21100515 1 No
Expiry : 30-Sep-26
LM:M/s DePuy Orthopaedics Inc., US
DC:1273
3 PFC MOD TIB TRAY CEM SZ 2.5 90213100 866029 1 No 16,600.00 No 16,600.00
Batch : D21084215 1 No
Expiry : 31-Aug-31
LM:DePuy Orthopaedics Inc., US
DC:1388
4 Smartset GHV Gentamicin 40G 30064000 3095040 1 No 0.01 No 0.01
Batch : 9880605 1 No
Expiry : 31-Aug-23
LM:DePuy Orthopaedics Inc., US
DC:1420
48,931.01
IGST 2,446.55

continued to page number 2

SUBJECT TO CHENNAI JURISDICTION
This is a Computer Generated Invoice
 Tax Invoice(Page 2) (DUPLICATE FOR TRANSPORTER)

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com
Dispatch Doc No. Delivery Note Date
Consignee (Ship to)
The Director ( BIRRD) Dispatched through Destination
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI Terms of Delivery
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

ROUND OFF 0.44

PATIENT NAME : P.VIRAMARAPPA
AGE : 59/M
DOCTOR NAME : DR.SANDEEP KRISHNA
IP NO : UMR10841
DATE OF IMPLANT : 2-Mar-22
(TKR/L)

Total 4 No 51,378.00
Amount Chargeable (in words) E. & O.E
INR Fifty One Thousand Three Hundred Seventy Eight Only
HSN/SAC Taxable Integrated Tax Total
Value Rate Amount Tax Amount

90213100 48,931.00 5% 2,446.55 2,446.55

30064000 0.01 5%
Total 48,931.01 2,446.55 2,446.55

Tax Amount (in words) : INR Two Thousand Four Hundred Forty Six and Fifty Five paise Only
Company’s PAN : AEVPD3749L
Declaration Company’s Bank Details
Bank Name : UNION BANK OF INDIA
We declare that this invoice shows the actual price of the A/c No. : 611701010050545
goods described and that all particulars are true and correct. Branch & IFS Code : WEST MAMBALAM & UBIN0561177

Customer’s Seal and Signature for SRI SAI AGENCIES

Authorised Signatory

SUBJECT TO CHENNAI JURISDICTION

This is a Computer Generated Invoice
 Tax Invoice (TRIPLICATE FOR SUPPLIER) e-Invoice

IRN : 876ea3c2def7a74fe15c983247bded8247a24-
26db961dada8ed2556bb1f314c8
Ack No. : 152211896634356
Ack Date : 4-Apr-22

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com Dispatch Doc No. Delivery Note Date

Consignee (Ship to) Dispatched through Destination

The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
Terms of Delivery
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37

Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

1 PFC SIGMA C/R NPOR FEM LT SZ 3 90213100 960003 1 No 22,667.00 No 22,667.00

Batch : D19012575 1 No
Expiry : 31-Dec-23
LM:M/s DePuy Orthopaedics Inc., US
DC:892
2 SIGMA CRVD GVF INS SIZE2.5 10MM 90213100 158112010 1 No 9,664.00 No 9,664.00

Batch : D21100515 1 No
Expiry : 30-Sep-26
LM:M/s DePuy Orthopaedics Inc., US
DC:1273
3 PFC MOD TIB TRAY CEM SZ 2.5 90213100 866029 1 No 16,600.00 No 16,600.00
Batch : D21084215 1 No
Expiry : 31-Aug-31
LM:DePuy Orthopaedics Inc., US
DC:1388
4 Smartset GHV Gentamicin 40G 30064000 3095040 1 No 0.01 No 0.01
Batch : 9880605 1 No
Expiry : 31-Aug-23
LM:DePuy Orthopaedics Inc., US
DC:1420
48,931.01
IGST 2,446.55

continued to page number 2

SUBJECT TO CHENNAI JURISDICTION
This is a Computer Generated Invoice
 Tax Invoice(Page 2) (TRIPLICATE FOR SUPPLIER)

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com
Dispatch Doc No. Delivery Note Date
Consignee (Ship to)
The Director ( BIRRD) Dispatched through Destination
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI Terms of Delivery
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

ROUND OFF 0.44

PATIENT NAME : P.VIRAMARAPPA
AGE : 59/M
DOCTOR NAME : DR.SANDEEP KRISHNA
IP NO : UMR10841
DATE OF IMPLANT : 2-Mar-22
(TKR/L)

Total 4 No 51,378.00
Amount Chargeable (in words) E. & O.E
INR Fifty One Thousand Three Hundred Seventy Eight Only
HSN/SAC Taxable Integrated Tax Total
Value Rate Amount Tax Amount

90213100 48,931.00 5% 2,446.55 2,446.55

30064000 0.01 5%
Total 48,931.01 2,446.55 2,446.55

Tax Amount (in words) : INR Two Thousand Four Hundred Forty Six and Fifty Five paise Only
Company’s PAN : AEVPD3749L
Declaration Company’s Bank Details
Bank Name : UNION BANK OF INDIA
We declare that this invoice shows the actual price of the A/c No. : 611701010050545
goods described and that all particulars are true and correct. Branch & IFS Code : WEST MAMBALAM & UBIN0561177

Customer’s Seal and Signature for SRI SAI AGENCIES

Authorised Signatory

SUBJECT TO CHENNAI JURISDICTION

This is a Computer Generated Invoice
 Tax Invoice (EXTRA COPY) e-Invoice

IRN : 876ea3c2def7a74fe15c983247bded8247a24-
26db961dada8ed2556bb1f314c8
Ack No. : 152211896634356
Ack Date : 4-Apr-22

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com Dispatch Doc No. Delivery Note Date

Consignee (Ship to) Dispatched through Destination

The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
Terms of Delivery
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37

Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

1 PFC SIGMA C/R NPOR FEM LT SZ 3 90213100 960003 1 No 22,667.00 No 22,667.00

Batch : D19012575 1 No
Expiry : 31-Dec-23
LM:M/s DePuy Orthopaedics Inc., US
DC:892
2 SIGMA CRVD GVF INS SIZE2.5 10MM 90213100 158112010 1 No 9,664.00 No 9,664.00

Batch : D21100515 1 No
Expiry : 30-Sep-26
LM:M/s DePuy Orthopaedics Inc., US
DC:1273
3 PFC MOD TIB TRAY CEM SZ 2.5 90213100 866029 1 No 16,600.00 No 16,600.00
Batch : D21084215 1 No
Expiry : 31-Aug-31
LM:DePuy Orthopaedics Inc., US
DC:1388
4 Smartset GHV Gentamicin 40G 30064000 3095040 1 No 0.01 No 0.01
Batch : 9880605 1 No
Expiry : 31-Aug-23
LM:DePuy Orthopaedics Inc., US
DC:1420
48,931.01
IGST 2,446.55

continued to page number 2

SUBJECT TO CHENNAI JURISDICTION
This is a Computer Generated Invoice
 Tax Invoice(Page 2) (EXTRA COPY)

SRI SAI AGENCIES Invoice No. Dated

No:2(1A), 1st Floor, Umpathy Street Extension, SSA/21-22/2433 2-Mar-22
West Mambalam, Near Shobhna Kalyanamantapa, Chennai Delivery Note Mode/Terms of Payment
DL.No:5803/M111/20B , 5682/M111/21B
GST.33AEVPD3749L1Z1, PH.7030472301 Buyer’s Order No. Dated
State Name : Tamil Nadu, Code : 33
E-Mail : srisaiagencieschennai@hotmail.com
Dispatch Doc No. Delivery Note Date
Consignee (Ship to)
The Director ( BIRRD) Dispatched through Destination
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI Terms of Delivery
State Name : Andhra Pradesh, Code : 37
Buyer (Bill to)
The Director ( BIRRD)
BIRRD (T) Hospital , Tirupathi, Tirupathi
GSTIN/UIN : 37AAATT4126G3ZI
State Name : Andhra Pradesh, Code : 37
Sl Description of Goods HSN/SAC Part No. Quantity Rate per Disc. % Amount

No.

ROUND OFF 0.44

PATIENT NAME : P.VIRAMARAPPA
AGE : 59/M
DOCTOR NAME : DR.SANDEEP KRISHNA
IP NO : UMR10841
DATE OF IMPLANT : 2-Mar-22
(TKR/L)

Total 4 No 51,378.00
Amount Chargeable (in words) E. & O.E
INR Fifty One Thousand Three Hundred Seventy Eight Only
HSN/SAC Taxable Integrated Tax Total
Value Rate Amount Tax Amount

90213100 48,931.00 5% 2,446.55 2,446.55

30064000 0.01 5%
Total 48,931.01 2,446.55 2,446.55

Tax Amount (in words) : INR Two Thousand Four Hundred Forty Six and Fifty Five paise Only
Company’s PAN : AEVPD3749L
Declaration Company’s Bank Details
Bank Name : UNION BANK OF INDIA
We declare that this invoice shows the actual price of the A/c No. : 611701010050545
goods described and that all particulars are true and correct. Branch & IFS Code : WEST MAMBALAM & UBIN0561177

Customer’s Seal and Signature for SRI SAI AGENCIES

Authorised Signatory

SUBJECT TO CHENNAI JURISDICTION

This is a Computer Generated Invoice