‫ﻣ ﺆ ﺳ ﺴ ﺔ ﻟ ﺆ ﻟ ﺆة ﺳ ﻔ ﺮ ا ﻟ ﺤ ﺎ ر ﺛ ﻲ ﻟﻠﺘ ﺠ ﺎ رة‬

‫ت‪.‬س ‪٤٠٣٠٢٧٠٧٥٩‬‬
‫رﻗﻢ اﻟﻀﺮﻳﺒﻲ ‪٣٠٢١٠٩٦٩٥٩٠٠٠٠٣‬‬

‫اﻟﻌﻤﻴﻞ ‪Buyer‬‬ ‫ﻓ ﺎ ﺗ ﻮ رة ﺿ ﺮ ﻳﺒﻴ ﺔ‬

‫ﻋ ﻄﺎ ر ة ﺳﺎ ﺑﺎ‬ ‫‪Tax Invoice‬‬
‫‪0509153061‬‬ ‫‪INV/2023/00006‬‬
‫‪2023-11-16‬‬

‫اﻟﻮ ﺻ ﻒ‬ ‫ا ﻟ ﻜ ﻤﻴ ﺔ‬ ‫اﻟ ﺴﻌﺮ‬ ‫اﻟ ﻤﺠ ﻤﻮ ع‬

‫‪Product‬‬ ‫‪Quantity‬‬ ‫‪Price‬‬ ‫‪Amount‬‬

‫زﻳ ﺖ‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬

‫ا ﻟ ﺒ ﻘ ﻨ ﺪ وﻧ ﺲ ‪ /‬ﺷ ﺮ ﻛ ﺔ‬
‫ﻛﻨ ﻮ ز‬
‫زﻳ ﺖ ﺟ ﻨ ﻴ ﻦ‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ﻗ ﻤ ﺢ ‪ /‬ﺷ ﺮ ﻛ ﺔ ا ﻟ ﻜ ﺎﺑ ﺘ ﻦ‬
‫زﻳﺖ ﺣﺒﺔ ]‪[30ML‬‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ا ﻟﺒ ﺮ ﻛ ﺔ ‪ /‬ﺷ ﺮ ﻛ ﺔ ﻛﻨ ﻮ ز‬
‫زﻳ ﺖ ا ﻟ ﺘ ﻴ ﻦ‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ﺷ ﻮﻛ ﻰ‪ /‬ﺷ ﺮﻛﺔ‬
‫ا ﻟ ﻜ ﺎﺑ ﺘ ﻦ‬
‫زﻳﺖ ]‪[30ML‬‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ﺟ ﻮ ﺟ ﻮﺑ ﺎ ‪ /‬ﺷ ﺮ ﻛ ﺔ ﻛ ﻨ ﻮ ز‬
‫زﻳﺖ ]‪[30ML‬‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ا ﻟ ﺴ ﻌ ﺪ ‪ /‬ﺷ ﺮ ﻛ ﺔ ﻛﻨ ﻮ ز‬
‫زﻳ ﺖ ا ﻟ ﺮﻳ ﺤ ﺎ ن ‪ /‬ﺷ ﺮ ﻛ ﺔ‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ﻛﻨ ﻮ ز‬
‫زﻳﺖ ]‪[30ML‬‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ا ﻟ ﺰ ﻋﺘ ﺮ ‪ /‬ﺷ ﺮ ﻛ ﺔ ﻛﻨ ﻮ ز‬
‫زﻳﺖ ﻛﺒﺪ ]‪[30ML‬‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ا ﻟ ﺤ ﻮ ت ‪ /‬ﺷ ﺮ ﻛ ﺔ ﻛﻨ ﻮ ز‬
‫زﻳﺖ ﻗﺮع ]‪[30ML‬‬ ‫‪2‬‬ ‫‪65.00‬‬ ‫‪130.00‬‬
‫ا ﻟ ﻌ ﺴ ﻞ ‪ /‬ﺷ ﺮ ﻛ ﺔ ﻛﻨ ﻮ ز‬
‫زﻳ ﺖ ﺧ ﺮ و ع ‪ /‬ﺷ ﺮ ﻛ ﺔ‬ ‫‪1‬‬ ‫‪65.00‬‬ ‫‪65.00‬‬
‫ﻛﻨ ﻮ ز‬

‫اﻟ ﻤ ﺠ ﻤ ﻮ ع‬ ‫‪SAR‬‬ ‫‪780.0‬‬

‫اﻟﻔ ﺮ ﻋ ﻲ‬
‫‪Taxable‬‬
‫‪Amount‬‬

‫إ ﺟ ﻤﺎﻟ ﻲ ﺿ ﺮ ﻳﺒ ﺔ‬ ‫‪SAR‬‬ ‫‪117.0‬‬

‫اﻟﻘﻴ ﻤ ﺔ اﻟ ﻤﻔﺎ ﺿ ﺔ‬
‫‪Tax Amount‬‬

‫ر ﻣ ﺰ ا ﻻ ﺳ ﺘ ﺠ ﺎ ﺑ ﺔ ا ﻟ ﺴ ﺮ ﻳ ﻌ ﺔ ﻣ ﺸ ﻔ ﺮ ﺑ ﺤ ﺴ ﺐ ﻣ ﺘ ﻄﻠ ﺒ ﺎ ت ﻫ ﻴ ﺌ ﺔ‬ ‫اﻹﺟ ﻤﺎﻟ ﻲ‬ ‫‪SAR‬‬ ‫‪897.0‬‬

‫ا ﻟ ﺰ ﻛ ﺎ ة و ا ﻟ ﻀ ﺮ ﻳ ﺒ ﺔ و ا ﻟ ﺠ ﻤ ﺎ ر ك ﻟﻠ ﻔ ﻮ ﺗ ﺮ ة ا ﻻ ﻟ ﻜ ﺘ ﺮ و ﻧ ﻴ ﺔ‬
‫‪This QR code is encoded as per ZATCA e-‬‬ ‫‪Total‬‬
‫‪invoicing requirements‬‬

‫‪Signature‬‬ ‫‪-------------------------------------------------------‬‬
‫‪-‬‬

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