Ref : DFT/SAL/03-1/3 Revision : 13 Date : 12-04-2008 Page : 5 of 5

DEALER ORDER FORM

DIRECT BILLING

FOR THE MONTH: -2012 ORD. REF. :( DLR CD/QTR No./YR BULK ORD. Ref. & Date

From:

To:

HINDUSTAN MOTORS LTD. HINDMOTOR DT.HOOGHLY

Prod.

Code

D E S C R I P T I O N

COLOUR

TOTAL QTY

AMBASSADOR GRAND 2.0 DSZ EURO III (Turbo products being replaced by NA products)
22543 22533 22553 22523 22513 22503 22563
Sl.No .

FSS FSS FSS BU BU BU BU AC AC AC AC AC

MRL MRL MRL MRL MRL MRL MRL

(NA) (NA) PS (NA) RSM (NA) RSM (NA) PS RSM (NA) PS RSM PW CL (NA)

CR/WHITE CR/WHITE CR/WHITE CR/WHITE CR/WHITE CR/WHITE CR/WHITE

MRL MOULDED ROOF LINER

RSM REMOTE GEAR SHIFT MECHANISM PS- POWER STEERING NA- NATURALLY ASPIRATED

Chq./DD / LC

Date

Bank

Amount (Rs.)

Remarks

IMPORTANT NOTE IF ANY

Dealers Signature with seal

For HM Internal use only Regional Control NO - Date : RAs Signature RM s Signature
Dealer shall ensure that Sales Tax declaration forms as per the statute, whereby the dealer becomes entitled to concessional rate of sales tax on purchase of products of the company or submitted within 15 days from the date of concerned purchase or such extended time period as may be specifically allowed by the company. In case of default, dealer shall be liable to pay the full rate of sales tax along with interest and penalty, as may be demanded by the company.