Tax Invoice
Original for recipient O
Duplicate for supplier O
Triplicate for transporter O
HERBALIFE INTERNATIONAL INDIA, PVT. LTD. Order No: 3I76604779
Thana No 66, PO Saidpur Halka,Afjalpur Page: 1 of 2
Hajipur,Vaishalli,Patna Sadar
Order Date: 09 JUN 2025
PATNA-844125,BIHAR
GSTIN: 10AAACH8025R2ZH Order Month: JUN
Factura: UP0049604
PAN: AAACH8025R Warehouse: UP
Invoice No: BRI0000335091
FSSAI License No 10013043000639 Order Type: RSO
Reverse Charge: No Invoice Date: 10 JUN 2025
Order Channel: Mobile
Purchased By : Ship To :
ID # : W1C5315788 Name : Suresh Kumar
Name : SURESH KUMAR
Address : Suresh Kumar
GSTIN :
PAN : Chakla , Nirmali
Ward no. 06
Sponsor : RANDHIR KUMAR YADAV (W110748497)
SUPAUL,BIHAR 852131
Address : CHAKLA , NIRMALI
WARD NO. 06
SUPAUL,BIHAR 852131
Place of Supply: BIHAR State: BIHAR
State Code: 10 State Code: 10
SL. SKU Description MRP Per Qty Retail Price Total Discount Taxable SGST CGST
No. Unit [Units] Per Unit Value Rate Amount Rate Amount
1 080K AFRESH ENERGY DRINK MIX - TULSI 913.00 1 773.00 773.00 157.50 615.50 9 55.40 9 55.39
HSN/SAC 21069099
2 1232 FORMULA 2 MULTIVITAMIN MINERAL & 2252.00 1 1908.00 1908.00 417.50 1490.50 9 134.15 9 134.14
HERBAL TABLETS HSN/SAC 21069099
3 1238 AFRESH ENERGY DRINK MIX-CINNAMON 913.00 1 773.00 773.00 169.25 603.75 9 54.34 9 54.33
HSN/SAC 21069099
4 1278 ACTIVATED FIBRE HSN/SAC 21069099 1839.00 1 1558.00 1558.00 341.00 1217.00 9 109.53 9 109.53
5 1294 AFRESH ENERGY DRINK MIX-ELAICHI 913.00 1 773.00 773.00 169.25 603.75 9 54.34 9 54.33
HSN/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 1569 PERSONALIZED PROTEIN POWDER-400G 2792.00 1 2366.00 2366.00 517.50 1848.50 9 166.37 9 166.36
HSN/SAC 21061000
8 230K AFRESH ENERGY DRINK MIX - KASHMIRI 913.00 1 773.00 773.00 169.25 603.75 9 54.34 9 54.33
KAHWA HSN/SAC 21069099
Delivery Charges SAC - 999799 0.00 0.00 0.00
Total 24255.00 5193.00 19062.00 1715.62 1715.51
Invoice Value (in words) Invoice Total: 22493.13
Twenty-two thousand four hundred ninety-three (Rounded off) Net Savings: 6136.87 [Total MRP (-) Order Total (excluding DC)]
SHIPPING INSTRUCTIONS/ EWAY BILL NO
LSP :
INVOICE WITH SHIPMENT Volume Points: 250.1
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:
[email protected] 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: 3I76604779
Thana No 66, PO Saidpur Halka,Afjalpur Page: 2 of 2
Hajipur,Vaishalli,Patna Sadar
Order Date: 09 JUN 2025
PATNA-844125,BIHAR
GSTIN: 10AAACH8025R2ZH Order Month: JUN
Factura: UP0049604
PAN: AAACH8025R Warehouse: UP
Invoice No: BRI0000335091
FSSAI License No 10013043000639 Order Type: RSO
Reverse Charge: No Invoice Date: 10 JUN 2025
Order Channel: Mobile
Purchased By : Ship To :
ID # : W1C5315788 Name : Suresh Kumar
Name : SURESH KUMAR
Address : Suresh Kumar
GSTIN :
PAN : Chakla , Nirmali
Ward no. 06
Sponsor : RANDHIR KUMAR YADAV (W110748497)
SUPAUL,BIHAR 852131
Address : CHAKLA , NIRMALI
WARD NO. 06
SUPAUL,BIHAR 852131
Place of Supply: BIHAR State: BIHAR
State Code: 10 State Code: 10
SL. SKU Description MRP Per Qty Retail Price Total Discount Taxable SGST CGST
No. Unit [Units] Per Unit Value Rate Amount Rate Amount
9 316K HN - SKIN BOOSTER CANISTER HSN/SAC 4394.00 1 3723.00 3723.00 712.25 3010.75 9 270.97 9 270.96
21069099
10 406K FORMULA 1 NUTRITIONAL SHAKE MIX - 3627.00 2 3073.00 6146.00 1344.50 4801.50 9 432.14 9 432.13
MANGO FLAVOUR (750 G) HSN/SAC
21069099
11 409K FORMULA 1 NUTRITIONAL SHAKE MIX - 3627.00 1 3073.00 3073.00 672.25 2400.75 9 216.07 9 216.06
KULFI FLAVOUR (750 G) HSN/SAC
21069099
12 426K SLEEP ENHANCE (30G) HSN/SAC 1907.00 1 1616.00 1616.00 353.50 1262.50 9 113.63 9 113.62
21069099
Delivery Charges SAC - 999799 0.00 0.00 0.00
Total 24255.00 5193.00 19062.00 1715.62 1715.51
Invoice Value (in words) Invoice Total: 22493.13
Twenty-two thousand four hundred ninety-three (Rounded off) Net Savings: 6136.87 [Total MRP (-) Order Total (excluding DC)]
SHIPPING INSTRUCTIONS/ EWAY BILL NO
LSP :
INVOICE WITH SHIPMENT Volume Points: 250.1
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: 10-Jun-2025 09:24:57 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:
[email protected] Website:www.myherbalife.com/en-in/ For Herbalife International India Pvt. Ltd.
Annexure
HERBALIFE INTERNATIONAL INDIA, PVT. LTD.
Order No : 3I76604779
Thana No 66, PO Saidpur Halka,Afjalpur Factura : UP0049604
Hajipur,Vaishalli,Patna Sadar
PATNA-844125,BIHAR
GSTIN: 10AAACH8025R2ZH
SL. BARCODE
SKU DESCRIPTION
NO.
1 080K AFRESH ENERGY DRINK MIX - TULSI HSN/SAC 21069099 U080KIN0020241235672
2 1232 FORMULA 2 MULTIVITAMIN MINERAL & HERBAL TABLETS HSN/ U1232IN1120241105555
SAC 21069099
3 1238 AFRESH ENERGY DRINK MIX-CINNAMON HSN/SAC 21069099 U1238IN2024006814059
4 1278 ACTIVATED FIBRE HSN/SAC 21069099 U1278IN0020244496369
5 1294 AFRESH ENERGY DRINK MIX-ELAICHI HSN/SAC 21069099 U1294IN2024011395893
6 1295 AFRESH ENERGY DRINK MIX-LEMON HSN/SAC 21069099 U1295IN2024047409979
7 1569 PERSONALIZED PROTEIN POWDER-400G HSN/SAC 21061000 U1569002025000004499
8 230K AFRESH ENERGY DRINK MIX - KASHMIRI KAHWA HSN/SAC U230KIN0120242026902
21069099
9 316K HN - SKIN BOOSTER CANISTER HSN/SAC 21069099 U316KIN0020240209581
10 406K FORMULA 1 NUTRITIONAL SHAKE MIX - MANGO FLAVOUR (750 G) U406K002025000073444
HSN/SAC 21069099
11 406K FORMULA 1 NUTRITIONAL SHAKE MIX - MANGO FLAVOUR (750 G) U406K002025000125620
HSN/SAC 21069099
12 409K FORMULA 1 NUTRITIONAL SHAKE MIX - KULFI FLAVOUR (750 G) U409K002025000880558
HSN/SAC 21069099
13 426K SLEEP ENHANCE (30G) HSN/SAC 21069099 U426KIN0120250231631
