Orignal for Recipient / Duplicate for Supplier / Triplicate for Warehouse

Delivery Challan (Defective/ Used Parts)

Name & Address of the Supplier Challan No. : SAM0000679699
S B TRADING CO Challan Date : 24/06/2021
B O 1st,Floor,Sadar Bazar Kathera Chowk Docket No. : 830485211192
Dhuri 148024 E-Way Bill No. :

Contact Number 91-9855111107 / Nature of Transaction Movement of Defective Parts

GSTIN 03ACJPK7115K2ZM State Code & Name 03-Punjab
PAN ACJPK7115K
ASC Code 0008304852

Name & Address of the Buyer

Samsung India Electronics Pvt. Ltd. Samsung Regd. Office 6th Floor, DLF Center,
C/O INGRAM MICRO INDIA PVT LTD 20 UDYOG VIHAR, ECOTECH-II Sansad Marg, New Delhi - 01
GREATER NOIDA, 201306

Contact Number 0120-4824677 / 0120-4824677 State Code & Name 09-Uttar Pradesh
GSTIN 09AAACS5123K4Z8 Place of Supply 09-Uttar Pradesh
PAN AAACS5123K
CIN U31900DL1995PTC071387

SI.No. Parts Code Description HSN Code Quantity Value (Rs.)

1 GH81-18537A SVC JDM-CAMERA KIT REAR MAIN+SUB_SM-A207 85258090 1 1.00
2 GH81-17797A SVC JDM-ETC RECEIVER_SM-A207F,SVC;SM-A20 85182100 1 1.00
3 GH81-17775A SVC JDM-SUB PBA SM-A207;SM-A207F,7152010 85177010 1 1.00
4 GH96-12078A ASSY OLED-6.0" FHD+ A750F BLACK WO LO AG 85177090 1 50.00
5 GH82-21190A SVC ASSY SMT-OCTA(E/ZK)SM-A307,SER,SVC;S 85177090 1 1.00
6 GH82-23878A SVC PBA-MAIN(COMM)SM-M013F/32DS,INS;SM-M 85177010 1 50.00
7 GH82-08533A SVC PBA-PBA MAIN(INDA);SM-B310E/D,INS,WH 85177010 1 50.00
8 GH82-21669A SVC ASSY SMT-OCTA(E/ZW),SM-A515F,CIS,SVC 85177090 1 1.00
9 GH96-12851A ASSY SUB PBA-HPCB;SM-A715F,EUR,45.980x24 85177010 1 1.00
10 GH82-22405A SVC ASSY SMT-OCTA(E/ZB)SM-M315,INS,AS;SM 85177090 1 1.00
11 GH82-24245A SVC PBA-MAIN(INDA)SM-F415F(6+64GB),INS,S 85177010 1 50.00
12 GH82-22761A SVC ASSY SMT-LCD(E/ZK),SM-A315F,SER,SVC; 85177090 1 1.00
13 GH59-15266A PBA-USB_SUB_SM-A315F;SM-A315F,VMA0315-01 85177010 1 1.00
14 GH82-22539A SVC PBA-MAIN(COMM)SM-A715F/1D8M;SM-A715F 85177010 1 50.00
15 GH82-08533A SVC PBA-PBA MAIN(INDA);SM-B310E/D,INS,WH 85177010 1 50.00
16 GH96-12851A ASSY SUB PBA-HPCB;SM-A715F,EUR,45.980x24 85177010 1 1.00
17 GH82-21379A SVC ASSY SMT-OCTA(E/ZK),SM-A707F,SVC,INS 85177090 1 1.00
18 GH82-22988A SVC ASSY SMT-LCD(E/ZK),SM-A217F,SER,SVC; 85177090 1 1.00
19 EB-U1200CPNGIN ACC HHP,BATTERY (LI-ION),U: UNI,UNIT 85076000 1 1.00
Total Amount (Rs.) 313.00

Total Amount in words : Rupees Three Hundred Thirteen and Zero Paise Only
1. This is to certify that these are defective parts collected for Testing/Verification purpose & have no commercial values and no sale Transaction is involved in this shipment.
2. Value shown above is for the purpose of transportation.
3. Any discrepancy, if any should be informed within 24 hours from the receipt of the parts.
For S B TRADING CO

Authorised Signatory

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 Orignal for Recipient / Duplicate for Supplier / Triplicate for Warehouse

SI.No. Parts Code Description HSN Code Quantity Value (Rs.)

(Sign & Stamp)

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