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Herbalife International India, Pvt. LTD

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Tax Invoice

Original for recipient O


Duplicate for supplier O
Triplicate for transporter O
HERBALIFE INTERNATIONAL INDIA, PVT. LTD. Order No: 3I51231297
Plot no C04, 05, Geeta Nagar Society, Page: 1 of 1
Nr Gujarat Gas Circle,Adajan Road,
Order Date: 14 DEC 2023
SURAT-395009,GUJARAT
GSTIN: 24AAACH8025R1Z9 Order Month: DEC
Factura: Z50037279
PAN: AAACH8025R Warehouse: Z5
Invoice No: GJI0001072377
FSSAI License No 10013043000639 Order Type: RSO
Reverse Charge: No Invoice Date: 15 DEC 2023
Order Channel: Internet

Purchased By : Ship To :
ID # : W1C2536836 Name : Madhuram Rohit
Name : RIZVANBHAI SELOT
Address : PU BY PB / Delivery Ends at
GSTIN :
PAN : NLEPS9607F Surat,Gujarat 395009
Sponsor : MADHURAM JOGANI (W1C1130439)
Address : A-7, SAINATH SOCIETY,
KAPODRA CHAR RASTA, VARACHHA.
SURAT,GUJARAT 395006

Place of Supply: Gujarat State: Gujarat


State Code: 24 State Code: 24

SL. SKU Description Qty Retail Price Total Discount Taxable SGST CGST
No. [Units] Per Unit Value
Rate Amount Rate Amount

1 0006 HERBAL ALOE CONCENTRATE HSN/SAC 1 2492.00 2492.00 763.35 1728.65 9 155.58 9 155.58
21069099

2 1295 AFRESH ENERGY DRINK MIX-LEMON 1 750.00 750.00 229.95 520.05 9 46.81 9 46.80
HSN/SAC 21069099

3 154K FORMULA 1 ROSE KHEER HSN/SAC 1 2015.00 2015.00 617.40 1397.60 9 125.79 9 125.78
21069099

4 1569 PERSONALIZED PROTEIN POWDER-400G 1 2297.00 2297.00 703.50 1593.50 9 143.42 9 143.41
HSN/SAC 21061000

5 2865 ACTIVE FIBER COMPLEX HSN/SAC 1 2366.00 2366.00 724.85 1641.15 9 147.71 9 147.70
21069099

Delivery Charges SAC - 999799 0.00 0.00 0.00


Total 9920.00 3039.05 6880.95 619.31 619.27
Invoice Value (in words) Invoice Total: 8119.53
Eight thousand one hundred nineteen (Rounded off)
SHIPPING INSTRUCTIONS/ EWAY BILL NO
LSP : Bluedart
Madhuram Rohit,8733057862

Volume Points: 114

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"
Date:

Regd.Office: RMZ Pinnacle, No. 15, Commissariat Road Bangalore – 560 025, Karnataka, India. CIN: U51909KA1998PTC026098.
Authorised Signatory
Tel: 080-40311444 Fax: 080-40311445 Email Id:inorderline@herbalife.com Website: www.myherbalife.com/en-in/ For Herbalife International India Pvt. Ltd.
Annexure

Order No : 3I51231297
HERBALIFE INTERNATIONAL INDIA, PVT. LTD.
Plot no C04, 05, Geeta Nagar Society, Factura : Z50037279
Nr Gujarat Gas Circle,Adajan Road,
SURAT-395009,GUJARAT
GSTIN: 24AAACH8025R1Z9

SL. BARCODE
SKU DESCRIPTION
NO.

1 0006 HERBAL ALOE CONCENTRATE HSN/SAC 21069099 U0006IN0020233414597

2 1295 AFRESH ENERGY DRINK MIX-LEMON HSN/SAC 21069099 U1295IN2023035257535

3 154K FORMULA 1 ROSE KHEER HSN/SAC 21069099 U154K002023005234251

4 1569 PERSONALIZED PROTEIN POWDER-400G HSN/SAC 21061000 U1569002023016267197

5 2865 ACTIVE FIBER COMPLEX HSN/SAC 21069099 U2865002023004644487

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