TAX INVOICE

Issued under GST Invoice Rules Original :For Recipient

Duplicate :For Supplier

Mr. DEEPAK MANI TRIPATHI Invoice No : ERKLGA2526000833

S/O: VYAS MANI TRIPATHI, NAGAR PANCHAYAT, PIPRAICH, Invoice Date :17/09/2025
GORAKHPUR Model : NEXON
GORAKHPUR, GORAKHPUR Chassis No : MAT635353SAD41406
ABHOORAM, 273165 Insurance Co : THE ORIENTAL INSURANCE CO. LTD.,
Uttar Pradesh(09) Insurance Type :
Phone No (Res,Off,Mob): , , 7880747694 Insurance Expiry Date :
Customer GSTIN : Kms. : 4558
A/C Code : 7-259U8L3D Vehicle Regn. No : UP53FJ6537
, Job Card No. : JC-RklAxm-GP2-2526-000694
, Job Card Date : 20/08/2025
(09) Service Request Type : Accident
Phone No (Res,Off,Mob): Customer P.O. No - Date :
Customer GSTIN : Payment Method : CREDIT
A/C Code : Warranty Expired :N
Place of Supply: 09-Uttar Pradesh Dealer PAN:AAGCR6855D
Dealer GSTIN : 09AAGCR6855D1Z4

PAN :
Total Insuran SGST/UTGS
Disc Campai CGST Total Amt
S Part#/Job Amt Extra ce Taxabl T
HSN/SAC Particulars Type UoM Qty Rate Amt/Ite gn Disc Disc % (Incl.
No Code (Base Chg Liability e Amt Rate Amoun Rate Amoun
m % Taxes)
Price) % % t % t
ASSY
7007.11.0 5438671001 INSURAN 6,717.
1 WINDSCRE Each 1 6,717.80 0 100 0.00 9 0.00 9 0.00 0.00
0 01 CE 80
EN GLASS
WINDSHIEL
D
3214.90.9 8855WORK ADHESIVE INSURAN
2 Each 2 922.88 1,845.76 0 100 0.00 9 0.00 9 0.00 0.00
0 0001 GLASS CE
SEALENT -
SUMA
FRONT
BUMPER
8708.10.9 5474885063 INSURAN 3,625.
3 SKIN W/O Each 1 3,625.78 0 100 0.00 14 0.00 14 0.00 0.00
0 32 CE 78
ULTRASONI
C SENSOR
6310.10.2 CONSCLOT
4 CLOTH Paid CM 1 23.81 23.81 0 23.81 2.5 0.60 2.5 0.60 25.00
0 H1
CLADDING
ASSY,
8708.99.0 5464881001 INSURAN
5 FRONT Each 1 886.72 886.72 0 100 0.00 14 0.00 14 0.00 0.00
0 02 CE
FENDER,
RH
8708.99.0 5464885001 CARRIER
6 Paid Each 1 488.28 488.28 0 488.28 14 68.36 14 68.36 625.00
0 22 ASSY,
 HEADLAMP
MTG,RH
BRACKET
ASSY,
8708.99.0 5464885001
7 BUMPER Paid Each 1 160.94 160.94 0 160.94 14 22.53 14 22.53 206.00
0 25
MTG,
FRONT-RH
PLASTIC
COMPONE
NT
WELDING/R
INSURAN
8 998714 980021 EPAIRS/PAI 1 0 0 1500 0.00 100 0.00 9 0.00 9 0.00 0.00
CE
NTINGDEN
TING AND
OPEANING
FITTING
PLASTIC
COMPONE
NT
WELDING/R INSURAN
9 998714 980021 1 0 0 1750 0.00 100 0.00 9 0.00 9 0.00 0.00
EPAIRS/PAI CE
NTINGGLA
SS
CUTTING
PLASTIC
COMPONE
NT
INSURAN
10 998714 980021 WELDING/R 1 0 0 10300 0.00 100 0.00 9 0.00 9 0.00 0.00
CE
EPAIRS/PAI
NTINGPAIN
TING

Sub Total: 673.03

Total Tax Amount : 182.97
Parts Net Taxable Amount : 673.03 Final Labour Invoice Amount : 0.00
----------------------------------------------------------
Final Parts Invoice Amount : 856.00

@ 2.5% CGST on Parts: 0.60

@ 2.5% SGST on Parts: 0.60
@ 14% CGST on Parts: 90.89
@ 14% SGST on Parts: 90.89
Gross Amount : 856.00
Adjustments : 0.00
Rupees Eight Hundred Fifty Six Only. Grand Total : 856.00

Note:
1) Insurance Liability % will only come for Insurance Job cards.

Tax Payable under Reverse Charge – No

Special Observations :
Terms and Conditions : E. & O. E.
1) Goods once sold will not be taken back or exchanged except as required by law.
2) Only the courts of GORAKHPUR shall have jurisdiction in any proceedings relating to this contract.
3) * Statistically generated based on Average kilometer's run per day.
4) I have inspected the vehicle UP53FJ6537 and taken delivery of the vehicle only after being satisfied regarding the maintenance work carried out in the vehicle. I do not
have any grievances/complaints pertaining to the chassis no MAT635353SAD41406
5) I hereby consent and authorize R K LAXMI GENERAL SALES LTD.-3008610 / GORAKHPUR and Tata Motors Passenger Vehicles Limited for usage of all the data
disclosed above and also to share all my details and documents for promotional, marketing and transactional activities of Tata Motors Passenger Vehicles Ltd. or any of
its group companies/subsidiaries/ authorized dealers, in accordance with Tata Motor's Privacy Policy. I shall inform in writing to Tata Motors Passenger Vehicles Limited,
if I intend to withdraw my aforesaid consent.
 For R K LAXMI GENERAL SALES LTD.-3008610

__________________ __________________
Customer's Signature Authorized signatory
Prepared By : SAMEER YADAV Date : 17/09/2025
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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R K LAXMI GENERAL SALES LTD.-3008610
* GATE PASS *
Customer Name : DEEPAK MANI TRIPATHI Invoice Ref. : ERKLGA2526000833 dated 17/09/2025
Vehicle No : UP53FJ6537 Invoice Amount : Rs. 856.00
Chassis No : MAT635353SAD41406 Job Card / Order ref : JC-RklAxm-GP2-2526-000694 dated
20/08/2025
Model Name : NEXON Gate Pass No & Date : __________________________________
____
Vehicle / Goods received in good condition and to our satisfaction.

___________________
Customer's Signature For R K LAXMI GENERAL SALES LTD.-3008610