Original/Reprint

1.Original Copy for Recipient

2.Duplicate Copy for Transporter
3.Triplicate for Supplier

GSTIN:

IRN:
Acknowledgement No.:
Acknowledgement Date:

Buyer Bill To Customer Consignee / Ship To Customer

Name : Name : Invoice No. :
Invoice Date :
Address: Place of Supply: Time of Issue :
Loadsheet No :
Transporter :

State Code/Name : State Code/Name : Truck No. :

Telephone : Telephone : Mode of Transport :

GSTIN/UIN : GSTIN/UIN : Trip Indicator :

LR No. :
FSSAI License No:
Other Details E-WAY BILL DETAILS
P.O Reference No E-WAY BILL :
E-WAY DATE:
E-WAY VALIDITY DATE :

8422901 FILTER CARTRIDGE 2.00/EA 11029. 22058.94 22058.94 18.00 3970.61 0.00 0.00 26029.55
0 301013309600 47
8477809 Output module__DO 232 1.00/EA 31470. 31470.64 31470.64 18.00 5664.72 0.00 0.00 37135.36
0 32x24V 64
8422901 Operating unit FC302 1.00/EA 7188.5 7188.57 7188.57 18.00 1293.94 0.00 0.00 8482.51
0 301268701505 7
8422901 Safety Relay_add-on elem 1.00/EA 7087.6 7087.67 7087.67 18.00 1275.78 0.00 0.00 8363.45
0 301265363220 7
Total (Quantities 0.00 c/s, 5.00 EA 0.00 KG)
TCS (Rounded Off) : 0.00

Grand Total(In Figures) : 67805.82 0.00 67805.82 12205.05 0 80010.87

Tax Amount in Words : Twelve Thousand Two Hundred Five Rupees Five Paise
Grand Total in Words : Eighty Thousand Ten Rupees Eighty Seven Paise
WHETHER TO REVERSE CHARGE APPLICABLE(Y/N) : NO

We hereby certify that our registration certificate under the Telangana State GST Law is in force on the date on which supply of goods/services specified in this tax invoice is made by us and that the transaction of supply
1
covered by this tax invoice has been effected by us.
2 The above mentioned shall be accounted for in the turnover of supply while filing of return and due tax,if any,payable on the supply.
3 Subject to Telangana State Jurisdiction only
4 Goods once supplied will not be taken back.
5 The glass bottles and crates marked with proprietary trade mark of The Coca-Cola Company are exclusive property of HINDUSTAN COCA-COLA BEVERAGES PVT. LTD.
6 The bottles and crates are not supplied. Only the beverages contained in the bottles is supplied and hence the bottles and crates are to be returned to Hindustan Coca-Cola Beverages Pvt Ltd. upon supply of beverage.
7 WARRANTY: This is to certify that the item supplied through this bill are tested and released by us. It meets company standard, local laws and regulatory requirements.
8 We certify that the foods mentioned in this Invoice is / are warranted to be of the nature & quality which it / these purports / purport to be.[ Form VI A(See rule 12-A) form of warranty].
9 Goods are supplied for delivery on 'FOR' basis. Our responsibility continues till the goods are handed over to the customer
10 The amortized cost of bottles and crates are included in the transaction value of beverages.
11 The usage cost of Interlayer sheets and pallets are included in the transaction value of beverages.

Page 1 of 2

Tel No : +91-9711144445, E-mail: [email protected],www.hccb.in

Original/Reprint
1.Original Copy for Recipient
2.Duplicate Copy for Transporter
3.Triplicate for Supplier

GSTIN:

IRN:
Acknowledgement No.:
Acknowledgement Date:

Buyer Bill To Customer Consignee / Ship To Customer

Name : Name : Invoice No. :
Invoice Date :
Address: Place of Supply: Time of Issue :
Loadsheet No :
Transporter :

State Code/Name : State Code/Name : Truck No. :

Telephone : Telephone : Mode of Transport :

GSTIN/UIN : GSTIN/UIN : Trip Indicator :

LR No. :
FSSAI License No:
Other Details E-WAY BILL DETAILS
P.O Reference No E-WAY BILL :
E-WAY DATE:
E-WAY VALIDITY DATE :

For Hindustan Coca-Cola Beverages Pvt. Ltd For Hindustan Coca-Cola Beverages Pvt. Ltd For Hindustan Coca-Cola Beverages Pvt. Ltd

Digitally signed by Tirupati Nayak

Tirupati Nayak DN: cn=Tirupati Nayak, c=IN, st=Karnataka, o=Hindustan

Coca-Cola Beverages Pvt. Ltd., [email protected]
Reason: I attest to the accuracy and integrity of this
M Babu M Babu document
Date: 2024.01.17 06:53:39 +00'00'

Prepared By Checked By Authorized Signatory

Page 2 of 2

Tel No : +91-9711144445, E-mail: [email protected],www.hccb.in