Original copy for recipient

DELIVERY CHALLAN - RTV Duplicate for consignee

Triplicate for consignor

Consignor: RELIEF MEDICAL STORES

164,NETAJI SUBHAS ROAD,HOWRAH-711101
Contact Person : DEBJANI
Contact No : 9239436914, 9239436914 Document No : ROSF11220004426
GSTIN : UNREGISTERED Date : 2022-06-06 14:07:25
DL.No : DL-3923-SB-21, DL-3935-S-20
Page No : Page 1 of 2
State : WEST BENGAL, 19

Consignee: RELIANCE RETAIL LIMITED

PPD-2,MOUZA-SANDHIPUR,J.L NO.04,R.S.DAG NO.801,802,806,807,808,809,817&819(ALL PART),POLICE
STATION-SANKRAIL,RRL HWRH-711302
GSTIN : 19AABCR1718E1ZM
DL.No : WB/HWH/NBO/R/592659-20-20, WB/HWH/NBO/W/592658-20B-20B,
WB/HWH/BIO/R/592659-21-21, WB/HWH/BIO/W/592658-21B-21B
FSSAI : 12821008000290
State : WEST BENGAL, 19

Place of Supply : WEST BENGAL- 19

Mfr. HSN Description of Goods CGST SGST

Amount
S.No Free
Batch Exp. Date MRP PTR Rate Qty Amount Disc% Disc. Amt Taxable Amt Rate Amt. Rate Amt. Incl.Tax
Qty

Alkem Labo 30049099 Glucoryl M 2mg Tablet 15'S

1
21442424 07-23 207.50 148.21 140.80 1 0 140.80 0.00 0.00 140.80 6.0 8.45 6.0 8.45 157.70
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049079 Tsart Trio 6.25mg Tablet 10'S
2
TTS21010SS 09-23 193.00 137.86 130.97 1 0 130.97 0.00 0.00 130.97 6.0 7.86 6.0 7.86 146.69
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049099 Olymprix M 1000mg Tablet 15'S
3
21442652 08-23 255.00 182.14 173.03 1 0 173.03 0.00 0.00 173.03 6.0 10.38 6.0 10.38 193.79
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049079 Cilnikem 10mg Tablet 10'S
4
21442789 08-23 105.00 75.00 71.25 1 0 71.25 0.00 0.00 71.25 6.0 4.28 6.0 4.28 79.80
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049035 Ondem MD 4mg Tablet 10'S
5
21443620 10-23 52.61 37.58 36.08 1 0 36.08 0.00 0.00 36.08 6.0 2.16 6.0 2.16 40.41
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049099 Euclide M OD 60mg Tablet 10'S
6
EUD21005PJ 09-23 125.00 89.29 84.83 1 0 84.83 0.00 0.00 84.83 6.0 5.09 6.0 5.09 95.01
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049099 Pentanerv NT 400/10mg Tablet 15'S
7
21443630 10-23 377.00 269.29 255.83 1 0 255.83 0.00 0.00 255.83 6.0 15.35 6.0 15.35 286.53
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049079 Tsart 40mg Tablet 15'S
8
21443534 10-23 110.97 79.26 76.09 1 0 76.09 0.00 0.00 76.09 6.0 4.57 6.0 4.57 85.22
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 21069099 Renocia Tablet 10'S
9
RNT21004TP 03-23 247.00 167.46 159.09 1 0 159.09 0.00 0.00 159.09 9.0 14.32 9.0 14.32 187.73
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30042095 CLINDAC A 1% Gel 20gm
10
I22007 12-23 225.00 171.43 162.86 1 0 162.86 0.00 0.00 162.86 2.5 4.07 2.5 4.07 171.00
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return
Alkem Labo 30049099 Glucoryl M2 Forte Tablet 15'S
11
21443526 10-23 195.00 139.29 132.33 1 0 132.33 0.00 0.00 132.33 6.0 7.94 6.0 7.94 148.21
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return

Continued..
 Original copy for recipient
DELIVERY CHALLAN - RTV Duplicate for consignee
Triplicate for consignor

Consignor: RELIEF MEDICAL STORES

164,NETAJI SUBHAS ROAD,HOWRAH-711101
Contact Person : DEBJANI
Contact No : 9239436914, 9239436914 Document No : ROSF11220004426
GSTIN : UNREGISTERED Date : 2022-06-06 14:07:25
DL.No : DL-3923-SB-21, DL-3935-S-20
Page No : Page 2 of 2
State : WEST BENGAL, 19

Consignee: RELIANCE RETAIL LIMITED

PPD-2,MOUZA-SANDHIPUR,J.L NO.04,R.S.DAG NO.801,802,806,807,808,809,817&819(ALL PART),POLICE
STATION-SANKRAIL,RRL HWRH-711302
GSTIN : 19AABCR1718E1ZM
DL.No : WB/HWH/NBO/R/592659-20-20, WB/HWH/NBO/W/592658-20B-20B,
WB/HWH/BIO/R/592659-21-21, WB/HWH/BIO/W/592658-21B-21B
FSSAI : 12821008000290
State : WEST BENGAL, 19

Place of Supply : WEST BENGAL- 19

Mfr. HSN Description of Goods CGST SGST

Amount
S.No Free
Batch Exp. Date MRP PTR Rate Qty Amount Disc% Disc. Amt Taxable Amt Rate Amt. Rate Amt. Incl.Tax
Qty

Alkem Labo 30049079 Olkem Trio 40mg Tablet 10'S

12
OTF21006SS 09-23 255.00 182.14 173.03 1 0 173.03 0.00 0.00 173.03 6.0 10.38 6.0 10.38 193.79
Sale Inv: CSSF11220037268 Dt.: 2022-05-14 06:51:11, Reason: Damaged Stock Return

Tax % CGST SGST IGST Total

Sub Total : 1,596.19
0% - - - -
Discount Amount : 0.00
5% 4.07 4.07 - 8.14
Tax Amount : 189.70
12% 76.46 76.46 - 152.92
Round Off : 0.11
18% 14.32 14.32 - 28.64
Net Amount : 1,786.00
28% - - - -

Total Items : 12 Total Qty : 12

for RELIEF MEDICAL STORES
Total Invoice Value Rs (in words): One Thousand Seven Hundred and Eighty Six
Rupees Only

Total Amount Payable Rs (in words): One Thousand Seven Hundred and Eighty Authorized signatory
Six Rupees Only