ORIGINAL

DUPLICATE
TAX INVOICE
TRIPLICATE

QUADRUPLICATE

JAYARAJ TRUCKS & BUSES PRIVATE LIMITED

12/70, Christhuraja Bhavan, Thirituvapuram Kuzhithurai
post, Kanyakumari Dist, Kuzhithurai,
Kuzhithurai,Kanniyakumari-629163, State: Tamil Nadu,
GSTIN : 33AACCJ6941J1ZH
IRN:
Acknowledge No Acknowledgement Date

Bill To Ship To Vehicle Info Invoice Info

Name SUBA N (30066520) Name SUBA N (30066520) VIN MEC987FCEPP141174 Invoice No CSJRTN1G25000089
Address D/O. NASAYAN, 17/116, Address D/O. NASAYAN, 17/116, Vehicle Reg No TN75AY1445 Invoice Date 15:04:2025 09:59:28
NARIYAN KADU VEEDU, NARIYAN KADU VEEDU,
PADANTHALUMOODU PADANTHALUMOODU PO
PO KANYAKUMARI-629163
KANYAKUMARI-629163
State Tamil Nadu State Tamil Nadu Model 4828RT Document No 9120330277
State Code 33 State Code 33 Estimate/Ref no
GSTIN GSTIN Order no CJR1GC0091
0001 Pay immediately w/o
Payment terms
deduction
Payment Mode CASH
Payment ID

Discount / Rebate CGST SGST/UTGST IGST

S.No. Part No. Description HSN Code Qty UoM Unit Price Total Price Taxable Total Parts
Rate (%) Amount Rate (%) Amount Rate (%) Amount Rate (%) Amount
Value Amount
BB Genuine
A4009892112
1 Adblue W Spout 3102 10 00 20 L 53.3900 1,067.80 0.00 0.00 1,067.80 9.00 96.10 9.00 96.10 0.00 0.00 1,260.00
1247
20 L

Sub Total 20 1,067.80 1,067.80 96.10 96.10 0.00 1,260.00

Other Charges
Discount / Rebate CGST SGST/UTGST IGST
S.No. Part No. Description SAC Code Qty UoM Unit Price Total Price Taxable Total Parts
Rate (%) Amount Value Rate (%) Amount Rate (%) Amount Rate (%) Amount Amount

Sub Total

Material-Tax Split Other Charges-Tax Split

Taxable Taxable Taxable Taxable Taxable Taxable

Tax% Amount Tax% Amount Tax% Amount Tax% Amount Tax% Amount Tax% Amount
amount amount amount amount amount amount
0.00 CGST@2.5 0.00 0.00 CGST@6 0.00 1,067.80 CGST@9 96.10 0.00 CGST@14 0.00 CGST@9 CGST@14

0.00 SGST@2.5 0.00 0.00 SGST@6 0.00 0.00 SGST@9 96.10 0.00 SGST@14 0.00 SGST@9 SGST@14

0.00 IGST@5 0.00 0.00 IGST@12 0.00 0.00 IGST@18 0.00 0.00 IGST@28 0.00 IGST@18 IGST@28

0.00 0.00 0.00 0.00 1,067.80 192.20 0.00 0.00

Total Invoice Value(in figure) : 1,260.00

Total Invoice Value(in words) : One Thousand Two Hundred Sixty Rupees Only

Declaration Remarks:

Terms and Conditions

1.All disputes are subject to Kanniyakumari ,Tamil Nadu jurisdiction only.

2.All services and supplies are subject to our business terms.

3.E&OE.

Customer Signature For JAYARAJ TRUCKS & BUSES PRIVATE LIMITED

Date: Authorized Signatory

Date:15:04:2025

Customer Support Center-Phone: 1800 300 12345 (Toll free) / 044 33411234; Email: dicv_service@daimler.com

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