Tax Invoice
Original for recipient O
Duplicate for supplier O
Triplicate for transporter O
HERBALIFE INTERNATIONAL INDIA, PVT. LTD. Order No: 3I69054470
Ground floor & Steel floor,Plot no C/948, Page: 1 of 2
CDA Sector-6, Near Union Bank
Order Date: 29 DEC 2024
Cuttack-753014,ORISSA
GSTIN: 21AAACH8025R1ZF Order Month: DEC
Factura: KC0044541
PAN: AAACH8025R Warehouse: KC
Invoice No: ODI0000994069
FSSAI License No 10013043000639 Order Type: RSO
Reverse Charge: No Invoice Date: 30 DEC 2024
Order Channel: Internet
Purchased By : Ship To :
ID # : W1C4777887 Name : SAYED SUHAIB
Name : SAFIYA BUSHRA
Address : SAYED SUHAIB
GSTIN :
PAN : NSCB ARCADE,DARGHA BAZAR
CUTTACK,ORISSA 753001
Sponsor : NASEHA BUSHRA (W1C4721804)
Address : MADRESA ALIYA,HATIPOKHARI,DARGHA BAZAR,
CUTTACK,ORISSA 753001
Place of Supply: ORISSA State: ORISSA
State Code: 21 State Code: 21
SL. SKU Description MRP Per Qty Retail Price Total Discount Taxable SGST CGST
No. Unit [Units] Per Unit Value Rate Amount Rate Amount
1 0006 HERBAL ALOE CONCENTRATE HSN/SAC 3030.00 1 2567.00 2567.00 561.50 2005.50 9 180.50 9 180.49
21069099
2 0111 CELL-U-LOSS HSN/SAC 21069099 1916.00 1 1623.00 1623.00 355.00 1268.00 9 114.12 9 114.12
3 1233 PERSONALIZED PROTEIN POWDER-200G 1455.00 1 1233.00 1233.00 269.75 963.25 9 86.69 9 86.69
HSN/SAC 21061000
4 127K WOMAN'S CHOICE HSN/SAC 21069099 1399.00 1 1185.00 1185.00 259.25 925.75 9 83.32 9 83.31
5 1291 AFRESH ENERGY DRINK MIX-GINGER HSN/ 913.00 1 773.00 773.00 169.25 603.75 9 54.34 9 54.33
SAC 21069099
6 1295 AFRESH ENERGY DRINK MIX-LEMON HSN/ 913.00 1 773.00 773.00 169.25 603.75 9 54.34 9 54.33
SAC 21069099
7 1458 HERBALIFE 24 HYDRATE HSN/SAC 1839.00 1 1558.00 1558.00 283.50 1274.50 9 114.71 9 114.70
21069099
8 183K SHAKE MATE HSN/SAC 21069099 733.00 1 621.00 621.00 76.50 544.50 9 49.01 9 49.00
9 2865 ACTIVE FIBER COMPLEX HSN/SAC 2876.00 1 2437.00 2437.00 533.25 1903.75 9 171.34 9 171.33
21069099
Delivery Charges SAC - 999799 0.00 0.00 0.00
Total 18995.00 4040.00 14955.00 1345.97 1345.90
Invoice Value (in words) Invoice Total: 17646.87
Seventeen thousand six hundred forty-six (Rounded off) Net Savings: 4774.13 [Total MRP (-) Order Total (excluding DC)]
SHIPPING INSTRUCTIONS/ EWAY BILL NO
LSP :
INVOICE WITH SHIPMENT Volume Points: 188.95
Guarantee: Name of Authorised Signatory
"We hereby certify that food/ foods mentioned in this invoice is/ are warranted
to be of the nature and quality which it/ these purports/ purported to be"
"The above products have been shipped. Remaining Products, if any from the Order, will be
shipped within 30 days from the receipt of the Order."
Date:
Regd.Office: P C Complex No.46/B-47, 1st Main Road, 3rd Phase, J.P.Nagar, Bengaluru – 560 078, Karnataka, India.
CIN: U51909KA1998PTC026098. Authorised Signatory
Toll Free:1800 102 2444 Fax:080-40311445 Email Id:preferredcustomer@herbalife.com Website:www.myherbalife.com/en-in/ For Herbalife International India Pvt. Ltd.
Tax Invoice
Original for recipient O
Duplicate for supplier O
Triplicate for transporter O
HERBALIFE INTERNATIONAL INDIA, PVT. LTD. Order No: 3I69054470
Ground floor & Steel floor,Plot no C/948, Page: 2 of 2
CDA Sector-6, Near Union Bank
Order Date: 29 DEC 2024
Cuttack-753014,ORISSA
GSTIN: 21AAACH8025R1ZF Order Month: DEC
Factura: KC0044541
PAN: AAACH8025R Warehouse: KC
Invoice No: ODI0000994069
FSSAI License No 10013043000639 Order Type: RSO
Reverse Charge: No Invoice Date: 30 DEC 2024
Order Channel: Internet
Purchased By : Ship To :
ID # : W1C4777887 Name : SAYED SUHAIB
Name : SAFIYA BUSHRA
Address : SAYED SUHAIB
GSTIN :
PAN : NSCB ARCADE,DARGHA BAZAR
CUTTACK,ORISSA 753001
Sponsor : NASEHA BUSHRA (W1C4721804)
Address : MADRESA ALIYA,HATIPOKHARI,DARGHA BAZAR,
CUTTACK,ORISSA 753001
Place of Supply: ORISSA State: ORISSA
State Code: 21 State Code: 21
SL. SKU Description MRP Per Qty Retail Price Total Discount Taxable SGST CGST
No. Unit [Units] Per Unit Value Rate Amount Rate Amount
10 4114 FORMULA 1 NUTRITIONAL SHAKE MIX- 2449.00 3 2075.00 6225.00 1362.75 4862.25 9 437.60 9 437.60
KULFI HSN/SAC 21069099
Delivery Charges SAC - 999799 0.00 0.00 0.00
Total 18995.00 4040.00 14955.00 1345.97 1345.90
Invoice Value (in words) Invoice Total: 17646.87
Seventeen thousand six hundred forty-six (Rounded off) Net Savings: 4774.13 [Total MRP (-) Order Total (excluding DC)]
SHIPPING INSTRUCTIONS/ EWAY BILL NO
LSP :
INVOICE WITH SHIPMENT Volume Points: 188.95
Guarantee: Name of Authorised Signatory
"We hereby certify that food/ foods mentioned in this invoice is/ are warranted
to be of the nature and quality which it/ these purports/ purported to be" Digitally Signed By
"The above products have been shipped. Remaining Products, if any from the Order, will be
shipped within 30 days from the receipt of the Order." ARNAB CHAKRABORTY
Date:
Date: 30-Dec-2024 21:59:36 IST
Regd.Office: P C Complex No.46/B-47, 1st Main Road, 3rd Phase, J.P.Nagar, Bengaluru – 560 078, Karnataka, India.
CIN: U51909KA1998PTC026098. Authorised Signatory
Toll Free:1800 102 2444 Fax:080-40311445 Email Id:preferredcustomer@herbalife.com Website:www.myherbalife.com/en-in/ For Herbalife International India Pvt. Ltd.
Annexure
HERBALIFE INTERNATIONAL INDIA, PVT. LTD.
Order No : 3I69054470
Ground floor & Steel floor,Plot no C/948, Factura : KC0044541
CDA Sector-6, Near Union Bank
Cuttack-753014,ORISSA
GSTIN: 21AAACH8025R1ZF
SL. BARCODE
SKU DESCRIPTION
NO.
1 0006 HERBAL ALOE CONCENTRATE HSN/SAC 21069099 U0006IN0020244750417
2 0111 CELL-U-LOSS HSN/SAC 21069099 U0111IN0120240372279
3 1233 PERSONALIZED PROTEIN POWDER-200G HSN/SAC 21061000 U1233002024046299781
4 127K WOMAN'S CHOICE HSN/SAC 21069099 U127KIN0020241838962
5 1291 AFRESH ENERGY DRINK MIX-GINGER HSN/SAC 21069099 U1291IN2024017162907
6 1295 AFRESH ENERGY DRINK MIX-LEMON HSN/SAC 21069099 U1295IN2024044141586
7 1458 HERBALIFE 24 HYDRATE HSN/SAC 21069099 U1458IN0020242556164
8 183K SHAKE MATE HSN/SAC 21069099 U183K002024035892949
9 2865 ACTIVE FIBER COMPLEX HSN/SAC 21069099 U2865002024006430546
10 4114 FORMULA 1 NUTRITIONAL SHAKE MIX-KULFI HSN/SAC 21069099 U4114002024023711832
11 4114 FORMULA 1 NUTRITIONAL SHAKE MIX-KULFI HSN/SAC 21069099 U4114002024023713964
12 4114 FORMULA 1 NUTRITIONAL SHAKE MIX-KULFI HSN/SAC 21069099 U4114002024023713976
