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TAX INVOICE ORIGINAL FOR RECIPIENT

(Service Invoice)
Name & Address of Seller: Name & Address of Buyer (Bill To) :1014036 Name & Address of Consignee (Ship To):1014036
M/s Fuji Film India pvt ltd Madhu Ortho & Trauma Centre Madhu Ortho & Trauma Centre
Unitech Cyber Park, 8th Floor, 8th mail 4th main Opp:patadikar kalyana Mandap
Unit No. 801-807, Tower C BANGALORE 8th mail
Sector -39, Gurugram 4th main Opp:patadikar kalyana Mandap BANGALORE
Postal Code: 122001 Postal Code: 560057 Contact No: 9739777624
Region Code: 06 Haryana Region Code: 29 Karnataka Postal Code : 560057
GSTIN :06AABCF1594J1ZK GSTIN: URP Region Code : 29 Karnataka
PAN :AABCF1594J PAN No. : AJEPH4458A GSTIN : URP
CIN :U24233DL2007PTC171054 PAN No. :AJEPH4458A

INVOICE NUMBER :1061714990 Customer Code :1014036 CARRIER NAME :

DATE :29.06.2019 PO NO. :AMC - FY - 2019-20 (Signed Copy) VEHICLE NUMBER

Ewaybill No. : PO DATE : LR/RR NO. / Date :


Delivery No. : Dispatch Through :
IGST CGST SGST
SR. Product HSN/SAC Product Description Qty UOM Unit Price Gross Value Discount Transaction Rate(%) Amount Rate(%) Amount Rate(%) Amount
Code CODE Value

1 13400080 998719 57212479 - CR PRIMA T - 1.000 AU 38,822.03 38,822.03 0.00 38,822.03 18.00 6,987.97 0.00 0.00 0.00 0.00
AMC
2 13400080 998719 57114709 - DP LITE - 1.000 AU 20,500.00 20,500.00 0.00 20,500.00 18.00 3,690.00 0.00 0.00 0.00 0.00
AMC

Terms of Payment:: 100% Advance Total Discount 0.00


Please make payment to "FUJIFILM INDIA PVT LTD." Deutsche Bank Account No - 9880401014036 Total Value 59,322.03
Sub Total 59,322.03
IGST Total 10,677.97
Advance Payment
General Terms:
Grand Total 70,000.00
Goods once sold shall not be taken back.
Disputes, If any, shall be subjected to courts of Delhi. Tax is payable under reverse charge: NA
Please receive the undermentioned goods intact per bearer and return the duplicate copy duly signed .
FUJIFILM INDIA PVT. LTD.
Total GST in Words :Ten Thousand Six Hundred Seventy Seven Rupees Ninety Seven Paise Only

Total Invoice Amount in Words :Seventy Thousand Rupees Only


Authorized Signatory
Period of contract : 01.06.2019 to 31.05.2021

Fujifilm India Pvt Ltd. Reg Offfice : Business Centre Office No. 521, Level V, Caddie Commercial Tower, Hospitality District Aero city, IGI Airport, New Delhi - 110037
Phone :- 011 -66544900 Fax :- 011-66544903 Mail : - contact@fujifilm.com Website :- www.fujifilm.in
Page 1 of 1
TAX INVOICE DUPLICATE FOR TRANSPORTER
(Service Invoice)
Name & Address of Seller: Name & Address of Buyer (Bill To) :1014036 Name & Address of Consignee (Ship To):1014036
M/s Fuji Film India pvt ltd Madhu Ortho & Trauma Centre Madhu Ortho & Trauma Centre
Unitech Cyber Park, 8th Floor, 8th mail 4th main Opp:patadikar kalyana Mandap
Unit No. 801-807, Tower C BANGALORE 8th mail
Sector -39, Gurugram 4th main Opp:patadikar kalyana Mandap BANGALORE
Postal Code: 122001 Postal Code: 560057 Contact No: 9739777624
Region Code: 06 Haryana Region Code: 29 Karnataka Postal Code : 560057
GSTIN :06AABCF1594J1ZK GSTIN: URP Region Code : 29 Karnataka
PAN :AABCF1594J PAN No. : AJEPH4458A GSTIN : URP
CIN :U24233DL2007PTC171054 PAN No. :AJEPH4458A

INVOICE NUMBER :1061714990 Customer Code :1014036 CARRIER NAME :

DATE :29.06.2019 PO NO. :AMC - FY - 2019-20 (Signed Copy) VEHICLE NUMBER

Ewaybill No. : PO DATE : LR/RR NO. / Date :


Delivery No. : Dispatch Through :
IGST CGST SGST
SR. Product HSN/SAC Product Description Qty UOM Unit Price Gross Value Discount Transaction Rate(%) Amount Rate(%) Amount Rate(%) Amount
Code CODE Value

1 13400080 998719 57212479 - CR PRIMA T - 1.000 AU 38,822.03 38,822.03 0.00 38,822.03 18.00 6,987.97 0.00 0.00 0.00 0.00
AMC
2 13400080 998719 57114709 - DP LITE - 1.000 AU 20,500.00 20,500.00 0.00 20,500.00 18.00 3,690.00 0.00 0.00 0.00 0.00
AMC

Terms of Payment:: 100% Advance Total Discount 0.00


Please make payment to "FUJIFILM INDIA PVT LTD." Deutsche Bank Account No - 9880401014036 Total Value 59,322.03
Sub Total 59,322.03
IGST Total 10,677.97
Advance Payment
General Terms:
Grand Total 70,000.00
Goods once sold shall not be taken back.
Disputes, If any, shall be subjected to courts of Delhi. Tax is payable under reverse charge: NA
Please receive the undermentioned goods intact per bearer and return the duplicate copy duly signed .
FUJIFILM INDIA PVT. LTD.
Total GST in Words :Ten Thousand Six Hundred Seventy Seven Rupees Ninety Seven Paise Only

Total Invoice Amount in Words :Seventy Thousand Rupees Only


Authorized Signatory
Period of contract : 01.06.2019 to 31.05.2021

Fujifilm India Pvt Ltd. Reg Offfice : Business Centre Office No. 521, Level V, Caddie Commercial Tower, Hospitality District Aero city, IGI Airport, New Delhi - 110037
Phone :- 011 -66544900 Fax :- 011-66544903 Mail : - contact@fujifilm.com Website :- www.fujifilm.in
Page 1 of 1
TAX INVOICE TRIPLICATE FOR ASSESEE
(Service Invoice)
Name & Address of Seller: Name & Address of Buyer (Bill To) :1014036 Name & Address of Consignee (Ship To):1014036
M/s Fuji Film India pvt ltd Madhu Ortho & Trauma Centre Madhu Ortho & Trauma Centre
Unitech Cyber Park, 8th Floor, 8th mail 4th main Opp:patadikar kalyana Mandap
Unit No. 801-807, Tower C BANGALORE 8th mail
Sector -39, Gurugram 4th main Opp:patadikar kalyana Mandap BANGALORE
Postal Code: 122001 Postal Code: 560057 Contact No: 9739777624
Region Code: 06 Haryana Region Code: 29 Karnataka Postal Code : 560057
GSTIN :06AABCF1594J1ZK GSTIN: URP Region Code : 29 Karnataka
PAN :AABCF1594J PAN No. : AJEPH4458A GSTIN : URP
CIN :U24233DL2007PTC171054 PAN No. :AJEPH4458A

INVOICE NUMBER :1061714990 Customer Code :1014036 CARRIER NAME :

DATE :29.06.2019 PO NO. :AMC - FY - 2019-20 (Signed Copy) VEHICLE NUMBER

Ewaybill No. : PO DATE : LR/RR NO. / Date :


Delivery No. : Dispatch Through :
IGST CGST SGST
SR. Product HSN/SAC Product Description Qty UOM Unit Price Gross Value Discount Transaction Rate(%) Amount Rate(%) Amount Rate(%) Amount
Code CODE Value

1 13400080 998719 57212479 - CR PRIMA T - 1.000 AU 38,822.03 38,822.03 0.00 38,822.03 18.00 6,987.97 0.00 0.00 0.00 0.00
AMC
2 13400080 998719 57114709 - DP LITE - 1.000 AU 20,500.00 20,500.00 0.00 20,500.00 18.00 3,690.00 0.00 0.00 0.00 0.00
AMC

Terms of Payment:: 100% Advance Total Discount 0.00


Please make payment to "FUJIFILM INDIA PVT LTD." Deutsche Bank Account No - 9880401014036 Total Value 59,322.03
Sub Total 59,322.03
IGST Total 10,677.97
Advance Payment
General Terms:
Grand Total 70,000.00
Goods once sold shall not be taken back.
Disputes, If any, shall be subjected to courts of Delhi. Tax is payable under reverse charge: NA
Please receive the undermentioned goods intact per bearer and return the duplicate copy duly signed .
FUJIFILM INDIA PVT. LTD.
Total GST in Words :Ten Thousand Six Hundred Seventy Seven Rupees Ninety Seven Paise Only

Total Invoice Amount in Words :Seventy Thousand Rupees Only


Authorized Signatory
Period of contract : 01.06.2019 to 31.05.2021

Fujifilm India Pvt Ltd. Reg Offfice : Business Centre Office No. 521, Level V, Caddie Commercial Tower, Hospitality District Aero city, IGI Airport, New Delhi - 110037
Phone :- 011 -66544900 Fax :- 011-66544903 Mail : - contact@fujifilm.com Website :- www.fujifilm.in
Page 1 of 1

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