Tax Invoice

S.S. AUTOMOBILE Invoice No:- Date:-

RAM NAGAR 509 24-Feb-18
K 1157 ASHIYANA OPPOSITE Delivery Note Mode/Terms of Payment
ASHIYANA THANA LUCKNOW
Mob :- 7007915832 Supplier's Ref. Other Reference(s)
E-mail :-
Buyer's Order No.
GSTIN NO:- 09ACUFS9669K1ZQ

Buyer:-
ICICI LOMBARD PVT LTD Despatch Document No. Dated
1st FLOOR ELDECO CORP CHAMBER VIBHUTI
LAND GOMTI NAGAR LUCKNOW Despatched through Destination

GSTIN NO:-09AAAC17904G1ZL Terms of Delivery

Mob:-
Amount Amount Amount
Sl.No. Description of Goods HSN Code Rate Quantity Per
Taxable @12% Taxable @18% Taxable @28%

1 H/L Assly 87141090 1.00 1214.84

2 Fr Auoy wheel 87141090 1.00 2617.19
3 Fr Shockker Tube Rep 998729 2.00 234.38
4 Au o/f 998729 390.63
5 C/f bill no 508 4468.75

Bank Details Amount 4.00 0.00 0.00 8925.78

Bank Name :- CGST 0.00 14 0.00 0.00 1249.61
Account Number :- SGST 0.00 14 0.00 0.00 1249.61
IFSC Code :- Total 0.00 0.00 11425.00
Bank Address :- Total Amount 11425.00
Freight 0.00
Round Off 0.00
Grand Total 11425.00
Amount Chargeable (in words) E. & O.E
For:- S.S. AUTOMOBILE

Company's VAT TIN:

Declaration
We declare that this invoice shows the actual price of the goods
described and that all particulars are true and correct.
Authorised Signatory

This is a Computer Generated Invoice

1555 1214.84 149850 166500 16650 149850 0
3350 2617.19
300 234.38
500 390.63
5720 4468.75