INDIA NON JUDICIAL

Government of National Capital Territory of Delhi

Certificate No. IN-DL02502838888627U

Certificate Issued Date 17-0ct-2022 01 :20 PM
Account Reference SELFPRINT (PU)/ dl-self/ NEHRU/ DL-DLH
Unique Doc. Reference SUBIN-DLDL-SELF83375534465693U
Purchased by REEMA BISHT
Description of Document Article 46 Partnership
Property Description PARTNERSHIP DEED
Consideration Price (Rs.) 0
(Zero)
First Party DIWAKAR VAISH
Second Party SWATISINGH
Stamp Duty Paid By DIWAKAR VAISH
Stamp Duty Amount(Rs.) 5,000
(Five Thousand only)

SELF PRINTED CERTIFICATE TO BE

VERIFIED BY THE RECIPIENT AT
WWW.SHCILESTAMP.COM
IH DL. G250283 8888 627U

Piease write or tyr;e below th•s line

SUPPLEMENTRY DEED OF PARTNERSHIP

THIS DEED is made on this 17th day of October, 2022' between: -

1. MR. DIWAKAR VAISH, 5/o. Sh. Uday Kumar Vaish, R/o D-45, ector 47,
(hereinafter referred to the Party of the first part).

Statutory Mort:
·1. The authenticity nf this
Any di~: crepanq,. in the
~~
:!., Tho onus of dmck!ng the
(

... 2 ...

2. MRS. SWATI SINGH, W/o. Sh. Deepak Aggarwal, R/o 74, Pragati Apartment, Paschim Vihar,
Club Road, New Delhi (hereinafter referred to the Party of the second part) .

WHEREAS the party of the first part & second part, has been carrying on business in Partnership
vide Supplementary Partnership Deed dated: 21.12.2021 to the original Partnership Deed dated
09.03.2018, and under the name & style of AgVa HEALTHCARE (hereinafter known as the "firm").

WHEREAS in the interest of smooth functioning and administration of the business of the firm it
has been decided between the parties to have Principle Administration cum Work Office at A01,
Sector 83 Block A Road, NOIDA, Gautam Buddha Nagar, Uttar
Pradesh, 201301. However, its registered office shall remain at Plot No. 7, Block No. 56, Khasra
No. 731/508, Desh Bandhu Gupta Road, Karol Bagh New Delhi 110005

1. That the other terms & conditions of partnership deed dated 09.03 .2018 & 21.12.2021 shall
apply to this deed as if there is no change therein.

IN WITNESS THEREOF the parties to this deed have signed in the presence of the wl ne s on the
17th day of October, 2022 .

{SWATI SINGH)
SECOND PARTY

AT ED

NOTA ,. PUBLIC
(I'NDIA)

'- 2 Nov . vL(. Page 2 o f 2

 AgVa
Annexure 1(a) PARTICULARS OF BIDDER

1 Name of the Bidder Company : Agva Healthcare

2 Tendering as : : Manufacturer
3 Name of the authorized person tosubmit : Mr. Diwakar Vaish
the Bid (Who holds DSC)
4 Telephone No of authorized person : 7607060712

5 Mobile no of the authorized person : 9818248829

6 Fax No of Bidder : NA
7 E mail ID of Bidder : [email protected],
[email protected]
8 Type of Legal Entity : Partnership Firm
9 Year of Incorporation/registration : 2018
10 Registered Address : Plot No. 7, Block No. 56, Khasra No. 731/508, Desh
Bandhu Gupta Road, Karol Bagh New Delhi 110005
11 Correspondence Address of HeadOffice : A-1 Sector 83 Noida 201301 UP (INDIA)

12 Telephone No of Head office : 7607060712

13 Fax No of Head office : NA

14 E mail ID of Head office : [email protected],
[email protected]
15 Correspondence Address oflocal : To be provided later
office, if any :
16 Telephone No of local office : To be provided later

17 Fax No of local office : To be provided later

18 E mail ID of local office : To be provided later
19 Name of The authorized : To be provided later
Distributor, if any :
20 Telephone No of authorized : To be provided later
Distributor, if any
21 Fax No of authorized Distributor, : To be provided later
22 E mail ID of authorized Distributor, : To be provided later

Signature of the authorized person

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
AgVa
FORMAT FOR CHECK LIST IN RESPECT OF

RE E-TENDER FOR PROCUREMENT OF DIFFERENT TYPES OF MACHINES FOR TWO

YEARS FROM THE DATE OF AWARD OF CONTRACT (AOC)

NIT No. HST/1P-140-2024/DTM-RT(310)/2024/325 Date 29-10-2024

Name of the Bidder: - AGVA HEALTHCARE

Full Address of the Bidder: A-1 Sector 83 Noida 201301 UP (INDIA)

E-Mail [email protected] , [email protected]

Contact person relating to Bidder & Mob.No. :- 7011803119, 9818248829

Tendering as: Manufacturer

Status of Manufacture: Others outside WB

Average Annual Turn Over Net of Taxes for last 3(three) financial years i.e. for the
years 2020-2021, 2021-2022 & 2022-2023 or of the Bidder: Rs 1,07,67,72,119/-CR,
83,60,72,827/- CR, 50,26,023/- CR

Name of the proposed Distributor, if any : To Be Provide By later

with Address.
Contact No.
(For Out-of-state Bidder only)

Folder
Sl. Particulars Pl mark
name &Page
No.
no
1. Application submitted in Annexure I Yes NA Technical Bid
✔ Page No. 00-00

2. Bidder’s Information Sheet in Annexure I(a)& Yes NA Technical Bid

I(b) Declaration on ManufacturingCapacity & ✔ Page No. 00-00
Sparable Capacity (in Non-
Judicial Stamp paper worth Rs. 100)

3 Authorization letter of signatory from the Yes NA Technical Bid

Company for DSC in Annexure II ✔ Page No. 00-00

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
AgVa
Folder name &
Sl. Particulars Pl mark ✔
Page no
No.

4. Annexure III ( Certification from Chartered Yes NA Technical Bid

Firmwith UDIN No. about the 10% of sale in ✔ Page No. 00-00
the open market for at least 2 (two) years
out ofpreceding 5 (five) years of the tender
(i.e.,2019-20 to 2023-24) & Annual Turnover
Net ofTaxes of the bidder)
5. Copy of agreement between the Manufacturer
and the Distributor as prescribed, if distributor
is proposed to be engaged in Annexure IV(a)

6. Certificate from CA Firm with UDIN about the To be Notify

annual Turn Over of the Distributor of the year
2022-23 or 2023-24 in Annexure IV(b)

7. Particular of the Distributor in Annexure IV(c)

8. Annexure V Declaration from existing CMS Yes NA Technical Bid
approved Vendor about supply of 80 % over ✔ Page No. 00-00
ordered value.

9. Affidavit for No Conviction from Notary Yes NA Technical Bid

✔ Page No. 00-00
Public/Judicial Magistrate/Executive Magistrate,
as per Annexure VI
10. Technical Data Sheet in excel sheet as provided Yes NA Technical Bid
✔ Page No. 00-00
11. Copy of PAN Card of the Bidder Company Yes NA Technical Bid
✔ Page No. 00-00
12. GST Registration Certificate Yes NA Technical Bid
✔ Page No. 00-00
13. Certificate of registration Yes NA Technical Bid
✔ Page No. 00-00

14. Trade Licence Yes NA Technical Bid

✔ Page No. 00-00
15 Registration with Registrar of Companies Yes NA Technical Bid
✔ Page No. 00-00
15a. BIS Certificate if any Yes NA Technical Bid
✔ Page No. 00-00

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
AgVa
Folder name
Sl. Particulars Pl mark ✔
&
No.
Page no

16. Drug / Medical Device Licence and its validity Yes NA Technical Bid
✔ Page No. 00-00
document

17. Up-to-date Drug / Medical Deviceendorsement

copy / Import License (MD-15) for To be Notify
each item quoted (marked with CMS Cat. No.)

18. Certificate of Market Standing / Marketing Yes NA Technical Bid

Certificate of the products from the Concerned ✔ Page No. 00-00
Manufacturing Licence Issuing Authority for
Two years out of preceding 5 (five) years of
the
tender.
19. Certificate for New drug from DCGI/State Drug
Control Office in terms of clause no 6(j) To be Notify

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
AgVa
Folder name
Sl. Particulars Pl mark ✔
&
No.
Page no

20. Current No-conviction certificate from the Yes NA Technical Bid

✔ Page No. 00-00
concerned Manufacturing issuing authority
21. Income Tax Returns submitted for the Yes NA Technical Bid
✔ Page No. 00-00
Assessment year 2022-23 & 2023-24
22. GST Returns for the year 2022-23 FY Yes NA Technical Bid
✔ Page No. 00-00
(any one month) (If applicable, if not applicable
self declaration is required)
23. Export-Import License with validity and IEC Yes NA Technical Bid
✔ Page No. 00-00
Code (for Direct Importers)

24. P/L Account & Balance Sheet with UDIN for the Yes NA Technical Bid
year 2020-2021, 2021-2022 & 2022-2023 ✔ Page No. 00-00

25. Related documents regarding IS / BIS / CE Yes NA Technical Bid

/FDA / USFDA certificates of the respective ✔ Page No. 00-00
items submitted

26. Brochure of the item(s) quoted must be Yes NA Technical Bid

✔ Page No. 00-00
submitted as per specification [if applicable]
27. A declaration should be submitted while Yes NA Technical Bid
submitting the BID whether the quoted item(s) ✔ Page No. 00-00

are tested in NABL Lab. / CDL or not.

28. Manufacturer shall submit the running factory
license from the concerned authority. To be Notify

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
 AgVa
Annexure I

APPLICATION FORMAT

(To be furnished in the Company’s official letter pad with full address and contact no, E mail address etc)
To
The Deputy Director of Health Services (E&S),
Central Medical Stores,
141, Acharya Jagadish Chandra Bose Road,
Kolkata – 700 014
Sub: E TENDER FOR PROCUREMENT OF CONSUMABLE ITEMS FOR TWO YEARS
FROM THE DATE OF AWARD OF CONTRACT (AOC)
Ref: - DDHS (E&S) N.I.T. No. HST/1P-140-2024/DTM-RT(310)/2024/325 Dated: 29-10-2024
Sir,

Having examined the pre-qualification & other documents published in the N.I.T,
I /we hereby submit all the necessary information and relevant documents for evaluation:

1. That the application is made by me / us on behalf of Agva Healthcare in the capacity CEO duly
authorized to submit the offer as a manufacturer. The authorization letter from the Company is attached in
Annexure II.

2. We accept the terms and conditions as laid down in the tender document and declare that we shall abide by
it for throughout the tender period including its extensions, if any.

3. We are offering rate for the item /items in the BOQ with manufacturing/importing capacity and assured
supply as per requirement of the NIT to the Health & Family Welfare Department, Government of West
Bengal.

4. We declare that we have achieved minimum 10% of sale of the the annual requirement as mentioned in the
tender documents in the domestic open market for at least 2 (two) years i.e. 2021-2022 and 2022-2023 out
of preceding 5 (five) years of the tender ( i.e., 2019-20 to 2023-24)

The certification from Chartered Firm is attached as per Annexure III.

5. We declare that we have not been convicted under any provision of Drug and Cosmetics Act, 1945 and any
other law in force from any competent authority or
by any Court of law.

6. A. We propose that the order and bill should be raised in our name. For this, We have appointed
M/S ……….………………………………………………….. having its office at ………………………,
Mobile No..….................... e-mail address …………… (address, contact no and e mail address) as
C&F agent /C&S (strike out whichever is not applicable) as per clause 11 of the NIT (This clause is
applicable for out of state manufacturers)

OR

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
 AgVa
b. We propose that order and bill should be raised in favour of our authorized distributor. For that purpose,
we have appointed .............…………………. having its office at………………………………
Mobile no ………………………… E mail address…….. ………………………………………….
(address with contact no and e mail address) as authorized Distributor who will receive order and payment
in his name on our behalf.

c. The agreement between ourselves and the distributor & other documents as prescribed is attached in
annexure IV(a), IV(b) & IV(c) (This clause is
applicable for out of state manufacturers).

1. We are the existing Bidders in the CMS / we are not the existing Bidder in the CMS (Pl strike out
whichever is not applicable).

2. Being an existing CMS approved item Bidder for the year 22-23, necessary declaration of items wise Good
Received Note (GRN) over ordered quantity through Store Management Information System (SMIS) is
given in Annexure V (applicable for existing Bidders only, others should strike out the clause)

3. In the event of being selected, I will make the supply within the stipulated period excepting the condition
which is beyond our control.

4. We understand that:

a. Tender Selection Committee/ H&FW Dept. can amend the scope & value of the contract bid under this
project.

b. Tender Selection Committee/ H&FW Dept. reserves the right to reject any application without
assigning any reason.

Date: - 21/11/2024 Signature of applicant including title

and capacity in which application is made.
Contact no: 7607060712 (seal)
Mobile: 9818248829
E mail address: [email protected]

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
AgVa
Annexure II

Authorization letter in favour of the applicant from the competent authority - (if theapplicant is not the Sole
Proprietor / Authority)

FORMAT

(To be furnished in the Company’s official letter pad with full address and contact no, Email address etc)

(TO WHOM IT MAY CONCERN)

This is to certify that Mr. Diwakar Vaish, employee of this Organization as…CEO is hereby authorized to submit tender online, Vide
NIT No:- HST/1P-140-2024/DTM-RT(310)/2024/325, Dated 29-10-2024 on behalf of the Organization. Sri Diwakar Vaish holds the
DSC from NIC to submit the bid on-line

Signature of the competent authority

Name: DIWAKAR VAISH

Designation: CEO

Seal

..................................................

(Signature of the Authorized Person)

Signature of MR. DIWAKAR VAISH................................................

(CEO), is hereby attested.

Signature of the competent authority

Name: MR.DIWAKAR VAISH

Designation: CEO

Seal

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
 4th Floor, Room No. 405,
23B, N. S. Road, Kolkata - 700 001
Ph. :9477554577,9433140027
NAHATANAHATA & ASSOCIATES
Chartered Accountants A E-mail : alka.nahata(@yaho0.co.in
[email protected]
Email : [email protected]
[email protected]

Annexure III
(Certificate from Chartered Firm in the official pad)
Ref. NIT No.
HST/1P-140-2024/TDTM-RT(310)/2024/325 Dated: 29-10-2024
This is to certify that having been examined the audited Balance Sheet & P/L
accounts and other
records of M/S AGVA HEALTHACRE having its office at A-1 Sector 83 Noida 201301 UP
(INDIA)
It is certified that M/S AGVA HEALTHACARE has achieved
minimum 10%o sale of the
requirement, as mentioned in the tender documents of each of the following product(s) annual
in the
Domestic Open Market for at least 2 (two) years i.e...2020-2021, 2021-2022 and 2022-2023 (Out
of preceding 5 (five)years of the tender (i.e.,2019-20 to 2023-24).
Name of the product(s)
SI. No. Name of the product CMS Cat No. For the year
1 Ventilator with accessories V-01(a) 2020-2021, 2021
2022 & 2022-2023
and

It is also certified that Annual Turnover Net of Taxes of the firm for the Financialyears
2020-202 1,
2021-2022 & 2022-2023 are Rs 1,07,67,72,1 19/-Cr., Rs 83,60,72,827Cr. & Rs50,26,023/-Cr.
respectively (as per P/L accounts & Balance Sheet of the firm submitted.

For Nahata Nahata& Associate

Firm Registration No. 328532E
Chartered Accountants
Countersigned
(Alka Nahata)
Proprietor
Signature of the authorised signatory (bidder) Membership No. 066649
UDIN -2406664qBuAoßG69e0
 PRAKASH K PRAKASH
CHARTERED ACCOUNTANTS

6H. HA SALAYA B ILDI G, 15, B RAKHAMBA ROAD.

CO A GHTPLACE. EWDELHI-110001
PHO E : +91-11-23312207, 23328753
pkpconsult1977@gmail .com. \-VWw.pkpconsult.com

TURNOVER CERTIFICATE

This is to certify that the Gross Turnover for the last three financial years of M/s. AgVa
Healthcare, having registered office at 7/56 First Floor, Desh Bandhu Gupta Road, Karol Bagh,
New Delhi -110055is as under:-

SNo. Financial Year Turnover ( in INR) ·

1 2020-21 1,07,67, 72,119/-

2 2021-22 83,60,72,827/-
3 2022-23 50,26,023/-

The above certificate is being issued on the basis of audited financial records of the firm produced
before us for our verification. Further, this. certificate has been issued at the request of the firm
for onward participation in the Tender ofGEM/2022/B/2563030.

For PRAKASH K PRAKASH

CHARTERED ACCOUNTANTS
ICAI FIRM REGN NO 000415N

New Delhi
OSTH April 2024

UDIN: 24505205BKAVMU8693
CN/PKP/1848/2024-25
 FORM MD-9

[See sub-rule (1) rule 25]

Licence to Manufacture for Sale or for Distribution of Class C or Class D medical device

Licence Number: MFG/MD/2024/000178

1. M/s AgVa Healthcare, A01, Sector 83 Block A Road, NOIDA, Gautam Buddha Nagar, Uttar Pradesh, 201301Noida,
Gautam Buddha Nagar, Uttar Pradesh (India) - 201301 Telephone No.: 9311337770 FAX: 9311337770 has been
licenced to manufacture for sale or for distribution the below listed medical device(s) at the premises situated at M/s
AgVa Healthcare, A01, Sector 83 Block A Road, NOIDA, Gautam Buddha Nagar, Uttar Pradesh, 201301, Gautam
Buddha Nagar, Uttar Pradesh (India) - 201301 Telephone No.: 7011803119 FAX: 7011803119

2. Details of medical device(s) [Annexed]

3. The names, qualifications and experience of the competent technical staff responsible for the manufacture and
testing of the above mentioned medical device(s): As per records maintain by the manufacturer

4. This licence is subject to the provisions of the Medical Devices Rules, 2017 and conditions prescribed therein.

ANNEXURE
S.No. Details Of Device(s)
Generic Name:Ventilators
1 Model No.:AgVa PRO - High End Turbine & 24 inch Display
Intended Use:AgVa Ventilators is a Mechanical Ventilators Designed to Provide
Invasive & Non- Invasive , Continuous or Intermittent , Respiratory Support to
Neonatal , Paediatrics & Adults Patients
Class of medical device:Class C
Material of construction:Mild Steel , Cast Iron, Acrylic , Stainless Steel 304 ,
Aluminium HE 30 , polypropylene , PVC , Silicon , Thermoplastic Polyurethane ,
Thermoplastic Vulcanisate
Dimension(if any):1520 * 460 * 420 mm
Shelflife:Nil
Sterile or Non sterile:Non-Sterilized
Brand Name(if registered under the Trade Marks Act, 1999):AgVa Pro Digitally signed by RAJEEV SINGH RAGHUVANSHI
DN: c=IN, o=CENTRAL DRUGS STANDARD CONTROL

RAJEEV SINGH ORGANIZATION, ou=RAJEEV SINGH RAGHUVANSHI,

2.5.4.20=80c62f6a23e4eafbe8a239774cdeb03c2769
041015a06564fe67f54b765db1cb,

RAGHUVANSHI
postalCode=600034, st=TAMIL NADU,
serialNumber=657F5E47D940985D8F03BDC902D0E
1FE73CFA12A1A126EA94FA5701124A19013,
cn=RAJEEV SINGH RAGHUVANSHI
Date: 2024.03.19 16:01:42 +05'30'

Place:

Date:19-Mar-24 Central Licensing Authority

Page 1 of 1
 Form MD-42
[See sub-rule(4) of rule 87A and sub-rule (1) of rule 87C]
REGISTRATION CERTIFICATE TO SELL, STOCK, EXHIBIT OR OFFER FOR SALE OR DISTRIBUTE A
MEDICAL DEVICE INCLUDING IN VITRO DIAGNOSTIC MEDICAL DEVICE

Registration No.: UP1642MD00025

1. M/s, AGVA HEALTHCARE situated at A01, Block A Road,, AgVa Healthcare, Noida Sector 83, Nepz Post
Office S.O, GAUTAM BUDDHA NAGAR, Uttar Pradesh, 201301, Contact No. 9311337770, Email ID :
[email protected] has been registered to sell, stock, exhibit or offer for sale or distribute a
medical device including in vitro diagnostic medical device under the Medical Devices Rules, 2017.
2. Name and qualification of competent person :

Name Qualification WorkRole Registration No

DIWAKAR VAISH Competent Person

3. This registration is subject to the conditions as specified in the Drugs and Cosmetics Act, 1940 (23 of 1940) and
the Medical Devices Rules, 2017.

Place : GAUTAM BUDDHA NAGAR

Date : 24/04/2023
Arvind Kumar Gupta
State Licensing Authority
GAUTAM BUDDHA NAGAR Division
DIWAKAR VAISH DIWAKAR VAISH

Note: This licence is valid till 23/04/2028. The licence holder should deposit retention
fee to extend validity of the licence on or before this date.

Digitally signed by
ARVIND KUMAR GUPTA
Date: 2023.04.24
20:39:22 IST
Acknowledgement Number:594797990301223

FORM 3CB [See rule 6G(1)(b)]

Audit report under section 44AB of the Income-tax Act, 1961, in the case of a person referred to in clause (b) of sub-rule (1) of rule 6G

1. I have examined the balance sheet as on 31st March 2023 , and the Profit and loss account
for the period beginning from 01-Apr-2022 to ending on 31-Mar-2023 attached herewith, of

Name AGVA HEALTHCARE

Address 7/56, FIRST FLOOR , DESH BANDHU GUPTA ROAD,

KAROL BAGH , 09-Delhi , 91-India , Pincode - 110005

PAN ABLFA3988M

Aadhaar Number of the assessee, if available

2. I certify that the balance sheet and the Profit and loss account are in agreement with the books of account maintained at the head office at 7/56,FIRST FLOOR,DESH
BANDHU GUPTA ROAD,KAROL BAGH,NEW DELHI and 1 branches.

3. a. I report the following observations/comments/discrepancies/inconsistencies if any:

b. Subject to above,-

A. I have obtained all the information and explanations which, to the best of My knowledge and belief, were necessary for the purposes of the audit.

B. In My opinion, proper books of account have been kept by the head office and branches of the assessee so far as appears from My examination of the books.

C. In My opinion and to the best of My information and according to the explanations given to Me the said accounts, read with notes thereon, if any, give a true and fair
view:-

i. In the case of the balance sheet, of the state of the affairs of the assessee as at 31st March 2023 ; and

ii. In the case of the Profit and loss account, of the Profit of the assessee for the year ended on that date.

4. The statement of particulars required to be furnished under section 44AB is annexed herewith in Form No. 3CD.

5. In My opinion and to the best of My information and according to the explanations given to Me , the particulars given in the said Form No. 3CD are true and correct,
subject to the following observations/qualifications, if any:

Sl. Qualification
Observations/Qualifications
No. Type

1 Others The assessee is responsible for the preparation of the aforesaid financial statements that give a true and fair view of the financial position
and financial performance (if applicable) in accordance with the applicable Accounting Standards issued by the Institute of Chartered
Accountants of India.This responsibility includes the design, implementation and maintenance of internal control relevant to the preparation
and presentation of the financial statements that give a true and fair view and are free from material misstatement,whether due to fraud or
error

2 Others Without qualifying our report regarding Clause 21(a) As explained to us & on the basis of our verification, there was no personal
expenditure / capital expenditure incurred by the assessee & is debited under profit & loss statement apart from any contractual obligation..

3 Others Without qualifying our report regarding clause 21(d)(A) & (B): It is not possible for us to verify whether the payments in excess of Rs.
10000/ -Rs. 35000/- covered u/s 40A(3)/(3A) respectively have been made otherwise than by way of Account Payee cheque/Bank Draft
since the necessary evidence is not in the possession of the assessee.

4 Others Without qualifying our report regarding clause 23 : For ascertaining the persons covered under section 40A (2)(b), we have relied on the list
provided by the assesse.

5 Others Without qualifying our report regarding clause 31(a) : It is not possible for me/us to verify whether loans or deposits have been taken or
accepted otherwise than by an account payee cheque or account payee bank draft, as the necessary evidence is not in the possession of
the assessee.

6 Others Without qualifying our report regarding clause 31(b). It is not possible for us to verify whether the receipts/ payments in an amount
exceeding the limit specified in section 269ST were received/ paid by cheque or bank draft not being an account payee cheque or an
account payee bank draft since the necessary evidence is not in the possession of the assessee.

7 Others Without qualifying our report regarding clause 34(a) : We have verified the compliance with the provisions of Chapter XVII-B / XVII-BB
regarding deduction of tax at source and regarding the payment thereof to the credit of the Central Government in accordance with the
Auditing Standards generally accepted in India which includes test checks and the concept of materiality. Such audit procedures did not
reveal any significant non-compliance with the provisions of Chapter XVII-B / XVII-BB.

8 Others The assesses firm has not maintained any stock records & closing stock details has been given on the basis of physical verification done
by the assesses on 31.03.2023.
Acknowledgement Number:594797990301223

FORM 3CD [See rule 6G(2)]

Statement of particulars required to be furnished under section 44AB of the Income-tax Act, 1961

PART - A

1. Name of the Assessee AGVA HEALTHCARE

2. Address of the Assessee 7/56, FIRST FLOOR , DESH BANDHU GUPTA ROAD,
KAROL BAGH , 09-Delhi , 91-India , Pincode - 110005

3. Permanent Account Number (PAN) ABLFA3988M

Aadhaar Number of the assessee, if available

4. Whether the assessee is liable to pay indirect tax like excise duty, service tax, sales tax, goods and services tax,customs Yes
duty,etc. if yes, please furnish the registration number or,GST number or any other identification number allotted for the same ?

Sl. No. Type Registration /Identification Number

1 Goods and Services Tax 07ABLFA3988M1ZP

09-Delhi

2 Goods and Services Tax 09ABLFA3988M1ZL

31-Uttar Pradesh

3 Other Indirect Tax/duty ABLFA3988M

Import Export Code

5. Status Firm

6. Previous year 01-Apr-2022 to 31-Mar-2023

7. Assessment year 2023-24

8. Indicate the relevant clause of section 44AB under which the audit has been conducted

Sl. No. Relevant clause of section 44AB under which the audit has been conducted

1 Third Proviso to sec 44AB : Audited under any other law

8(a). Whether the assessee has opted for taxation under section 115BA / 115BAA / 115BAB / 115BAC / 115BAD ? No

Section under which option exercised

PART - B

9.(a). If firm or Association of Persons, indicate names of partners/members and their profit sharing ratios. In case of AOP, whether
shares of members are indeterminate or unknown?

Sl. No. Name Profit Sharing Ratio (%)

1 DIWAKAR VAISH 50

2 SWATI SINGH 50

(b). If there is any change in the partners or members or in their profit sharing ratio since the last date of the preceding year, the No
particulars of such change ?

Sl. No. Date of change Name of Partner/Member Type of change Old profit sharing ratio (%) New profit Sharing Ratio (%) Remarks

No records added

10.(a). Nature of business or profession (if more than one business or profession is carried on during the previous year, nature of
every business or profession).

Sl. No. Sector Sub Sector Code

Acknowledgement Number:594797990301223

1 MANUFACTURING Manufacture of medical and surgical equipment 04079

(b). If there is any change in the nature of business or profession, the particulars of such change ? No

Sl. No. Business Sector Sub Sector Code

No records added

11.(a). Whether books of accounts are prescribed under section 44AA, if yes, list of books so prescribed ? No

Sl. No. Books prescribed

No records added

(b). List of books of account maintained and the address at which the books of accounts are kept. (In case books of account are
maintained in a computer system, mention the books of account generated by such computer system. If the books of accounts are
not kept at one location, please furnish the addresses of locations along with the details of books of accounts maintained at each
location.)

Books Address Address City Or Town Or

Sl. No. Zip Code / Pin Code Country State
maintained Line 1 Line 2 District

1 Cash Book 19, Block Noida, Noida 201301 91-India 31-Uttar Pradesh
(Computerized) A, Sector Gautam
4 Buddha
Nagar

2 Journal 19, Block Noida, Noida 201301 91-India 31-Uttar Pradesh

(Computerized) A, Sector Gautam
4 Buddha
Nagar

3 Bank Book 19, Block Noida, Noida 201301 91-India 31-Uttar Pradesh
(Computerized) A, Sector Gautam
4 Buddha
Nagar

4 Ledger 19, Block Noida, Noida 201301 91-India 31-Uttar Pradesh

(Computerized) A, Sector Gautam
4 Buddha
Nagar

5 Sales Register 19, Block Noida, Noida 201301 91-India 31-Uttar Pradesh
(Computerized) A, Sector Gautam
4 Buddha
Nagar

6 Purchases 19, Block Noida, Noida 201301 91-India 31-Uttar Pradesh

Register A, Sector Gautam
(Computerized) 4 Buddha
Nagar

(c). List of books of account and nature of relevant documents examined.

Sl. No. Books examined

1 Cash Book

2 Journal

3 Bank Book

4 Ledger

5 Sales Register

6 Purchases Register
Acknowledgement Number:594797990301223

12. Whether the profit and loss account includes any profits and gains assessable on presumptive basis, if yes, indicate the No
amount and the relevant section (44AD, 44ADA, 44AE, 44AF, 44B, 44BB, 44BBA, 44BBB, Chapter XII-G, First Schedule or any
other relevant section.) ?

Sl. No. Section Amount

No records added

13.(a). Method of accounting employed in the previous year. Mercantile system

(b). Whether there had been any change in the method of accounting employed vis-a-vis the method employed in the immediately No
preceding previous year ?

(c). If answer to (b) above is in the affirmative, give details of such change , and the effect thereof on the profit or loss ?

Sl. No. Particulars Increase in profit Decrease in profit

No records added

(d). Whether any adjustment is required to be made to the profits or loss for complying with the provisions of income computation No
and disclosure standards notified under section 145(2) ?

(e). If answer to (d) above is in the affirmative, give details of such adjustments:

Sl. No. ICDS Increase in profit Decrease in profit Net effect

No records added

(f). Disclosure as per ICDS:

Sl.
ICDS Disclosure
No.

1 ICDS I - Accounting The financial statements have been prepared in accordance with the Generally Accepted Accounting Principles in India(Indian
Policies GAAP).The financial statements have been prepared under the historical cost convention on going Concern & accrual basis and
are consistent with last year policies.

2 ICDS II - Valuation of The Basis of determination of cost for different categories of inventories is as follows: Raw Material- At cost. Finished Goods-At
Inventories Cost or Net Realizable value whichever is lower. Work in Progress-The Cost includes- Material Cost, Labour and appropriate share
of Manufacturing and other costs incurred in bringing the inventories to the present location and condition.

3 ICDS III - Construction Since the Firm is not into construction activities, provisions of this ICDS is not applicable.
Contracts

4 ICDS IV - Revenue Transaction involving sale of good, total amount not recognized as revenue during previous year due to lack of reasonably certainty
Recognition of ultimate collection along with nature of uncertainty is Rs Nil. The amount of revenue from Sale transactions recognized as
revenue during the previous year Rs 50,26,023. The method used to determine the stage of completion of service transactions in
progress- There is no Service which is under progress as on date of Balance Sheet. For service transactions in progress at the end
of previous year is Nil

5 ICDS V - Tangible Fixed As per Point 18 of this report.

Assets

6 ICDS VII - Governments The firm has not received any govt grants during the year.
Grants

7 ICDS IX - Borrowing Borrowing costs attributable to acquisition of specific qualifying asset are capitalized till the date the asset is put to use, and all
Costs other borrowing costs are charged to Profit and Loss Account unless the period of qualifying asset are capitalized after 12 months.
Interest Cost Capitalized during the year is Rs Nil.

8 ICDS X - Provisions, The firm has not made provision of any Contingent Liability ad neither has recorded any Contingent assets as required in this ICDS
Contingent Liabilities
and Contingent Assets
Acknowledgement Number:594797990301223

14.(a). Method of valuation of closing stock employed in the previous year Lower of Cost or Market Rate

(b). In case of deviation from the method of valuation prescribed under section 145A, and the effect thereof on the profit or loss, No
please furnish:

Sl. No. Particulars Increase in profit Decrease in profit

No records added

15. Give the following particulars of the capital asset converted into stock-in-trade

Sl. Description of capital asset Date of acquisition Cost of acquisition Amount at which the asset is converted into stock-in trade
No. (a) (b) (c) (d)

No records added

16. Amounts not credited to the profit and loss account, being, -

(a). The items falling within the scope of section 28;

Sl. No. Description Amount

No records added

(b). The proforma credits, drawbacks, refunds of duty of customs or excise or service tax, or refunds of sales tax or value added tax or Goods & Services Tax, where such
credits, drawbacks or refunds are admitted as due by the authorities concerned;

Sl. No. Description Amount

No records added

(c). Escalation claims accepted during the previous year;

Sl. No. Description Amount

No records added

(d). any other item of income;

Sl. No. Description Amount

₹0

(e). Capital receipt, if any.

Sl. No. Description Amount

No records added

17. Where any land or building or both is transferred during the previous year for a consideration less than value adopted or
assessed or assessable by any authority of a State Government referred to in section 43CA or 50C, please furnish:

Sl. Details Address of Property Consideration Value Whether provisions of

No. of received or adopted or second proviso to
property accrued assessed or sub-section (1) of
Address Address City Or Zip Country State assessable section 43CA or
Line 1 Line 2 Town Or Code fourth proviso to
District /Pin clause (x) of sub-
Code section (2) of section
56 applicable ?
Acknowledgement Number:594797990301223

No records added

18. Particulars of depreciation allowable as per the Income-tax Act, 1961 in respect of each asset or block of assets, as the case
may be, in the following form:-

Sl. Method of Description Rate Opening Adjustment Adjustment Adjusted Purchase Total Deductions Other Depreciation Written
No. Depreciation of the Block of WDV/Actual made to the made to written Value Value of (C) Adjustments Allowable Down
of Depre written down the written down Purchases (D) Value at
Assets/Class ciatio value under down value value(A) (B) the end
of Assets n (%) section of of the
115BAC/115B Intangible year(A+B-
AD (for asset due C-D)
assessment to
year 2021-22 excluding
only) value of
goodwill of
a business
or
profession

1 WDV Furnitures & 10 ₹10,01,924 ₹0 ₹0 ₹10,01,924 ₹0 ₹0 ₹0 ₹0 ₹1,00,192 ₹

Fittings @ 9,01,732
10%

2 WDV Plant and 15 ₹67,94,231 ₹0 ₹0 ₹67,94,231 ₹38,12,397 ₹38,12,397 ₹0 ₹0 ₹15,87,815 ₹

Machinery @ 90,18,813
15%

3 WDV Plant and 40 ₹32,86,553 ₹0 ₹0 ₹32,86,553 ₹76,195 ₹76,195 ₹0 ₹0 ₹13,29,860 ₹

Machinery @ 20,32,888
40%

4 WDV Plant and 30 ₹12,11,000 ₹0 ₹0 ₹12,11,000 ₹0 ₹0 ₹0 ₹0 ₹3,63,300 ₹

Machinery @ 8,47,700
30%

19. Amount admissible under section-

Amount debited to Amounts admissible as per the provisions of the Income-tax Act, 1961 and also fulfils the conditions, if any
Sl.
Section profit and loss specified under the relevant provisions of Income-tax Act, 1961 or Income-tax Rules, 1962 or any other
No.
account guidelines, circular, etc., issued in this behalf.

No records added

20. (a).Any sum paid to an employee as bonus or commission for services rendered, where such sum was otherwise payable to him as profits or dividend. [Section 36(1)
(ii)]

Sl. No. Description Amount

No records added

(b).Details of contributions received from employees for various funds as referred to in section 36(1)(va):

Sl. Sum received from Due date for The actual The actual date of payment to the
Nature of fund
No. employees payment amount paid concerned authorities

1 Provident Fund ₹ 1,15,124 15-May-2022 ₹ 2,41,781 23-May-2022

2 Provident Fund ₹ 1,09,893 15-Jun-2022 ₹ 2,19,783 16-Jun-2022

3 Provident Fund ₹ 1,09,405 15-Jul-2022 ₹ 2,18,811 18-Jul-2022

4 Provident Fund ₹ 98,366 15-Aug-2022 ₹ 1,96,732 22-Aug-2022

5 Provident Fund ₹ 1,875 15-Aug-2022 ₹ 3,750 09-Sep-2022

6 Provident Fund ₹ 98,583 15-Sep-2022 ₹ 1,97,165 09-Sep-2022

7 Provident Fund ₹ 2,951 15-Sep-2022 ₹ 6,148 19-Dec-2022

8 Provident Fund ₹ 1,06,529 15-Oct-2022 ₹ 2,13,058 19-Oct-2022

Acknowledgement Number:594797990301223

9 Provident Fund ₹ 1,875 15-Oct-2022 ₹ 3,750 19-Dec-2022

10 Provident Fund ₹ 1,02,392 15-Nov-2022 ₹ 2,04,785 14-Dec-2022

11 Provident Fund ₹ 96,423 15-Dec-2022 ₹ 1,92,846 19-Dec-2022

12 Provident Fund ₹ 1,803 15-Dec-2022 ₹ 4,034 19-Dec-2022

13 Provident Fund ₹ 1,03,050 15-Jan-2023 ₹ 2,06,100 13-Dec-2023

14 Provident Fund ₹ 1,06,202 15-Feb-2023 ₹ 2,12,405 15-Mar-2023

15 Provident Fund ₹ 1,02,387 15-Mar-2023 ₹ 2,04,776 15-Mar-2023

16 Provident Fund ₹ 97,439 15-Apr-2023 ₹ 2,02,998 16-May-2023

17 Provident Fund ₹ 930 15-Apr-2023 ₹ 2,399 16-May-2023

18 Any fund setup under the provisions of ₹ 3,694 15-May-2022 ₹ 19,674 23-May-2022
ESI Act, 1948

19 Any fund setup under the provisions of ₹ 3,062 15-Jun-2022 ₹ 16,303 16-Jun-2022
ESI Act, 1948

20 Any fund setup under the provisions of ₹ 2,795 15-Jul-2022 ₹ 14,885 18-Jul-2022
ESI Act, 1948

please note: Post filing, the complete records will be available for download as a separate file in the download section.
Generated_Form3cdEmpPfSuperann.csv

21.(a). Please furnish the details of amounts debited to the profit and loss account, Being in the nature of capital, personal,
advertisement expenditure etc.

Capital expenditure

Sl. No. Particulars Amount

No records added

Personal expenditure

Sl. No. Particulars Amount

No records added

Advertisement expenditure in any souvenir, brochure, tract, pamphlet or the like published by a political party

Sl. No. Particulars Amount

No records added

Expenditure incurred at clubs being entrance fees and subscriptions

Sl. No. Particulars Amount

No records added

Expenditure incurred at clubs being cost for club services and facilities used.

Sl. No. Particulars Amount

No records added

Expenditure by way of penalty or fine for violation of any law for the time being in force

Sl. No. Particulars Amount

No records added
Acknowledgement Number:594797990301223

Expenditure by way of any other penalty or fine not covered above

Sl. No. Particulars Amount

No records added

Expenditure incurred for any purpose which is an offence or which is prohibited by law

Sl. No. Particulars Amount

No records added

(b). Amounts inadmissible under section 40(a);

i. as payment to non-resident referred to in sub-clause (i)

A. Details of payment on which tax is not deducted:

Sl. Date of Amount of Nature of Name of Permanent Account Number of Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment payment the payee the payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

B. Details of payment on which tax has been deducted but has not been paid on or before the due date specified in sub-section (1)
of section 139

Sl. Date of Amount Nature of Name of Permanent Account Aadhaar Number of Address Address City Or Zip Code Country State Amount of
No. payment of payment the Number of the payee,if the payee, if Line 1 Line 2 Town Or / Pin tax
payment payee available available District Code deducted

No records added

ii. as payment referred to in sub-clause (ia)

A. Details of payment on which tax is not deducted:

Sl. Date of Amount of Nature of Name of Permanent Account Number of Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment payment the payee the payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

B. Details of payment on which tax has been deducted but has not been paid on or before the due date specified in sub-section (1)
of section 139.

Sl. Date of Amount Nature Name Permanent Account Aadhaar Number Address Address City Or Zip Country State Amount Amount
No. payment of of of the Number of the of the payee, if Line 1 Line 2 Town Or Code / of tax deposite
payment payment payee payee,if available available District Pin deducte d out of
Code d "Amoun
t of tax
deducte
d"

No records added

iii. as payment referred to in sub-clause (ib)

A. Details of payment on which levy is not deducted:

Sl. Date of Amount of Nature of Name of Permanent Account Number of Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment payment the payee the payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

B. Details of payment on which levy has been deducted but has not been paid on or before the due date specified in sub-section
(1) of section 139.

Sl. Date of Amount Nature Name Permanent Account Aadhaar Number Address Address City Or Zip Country State Amount Amount
No. payment of of of the Number of the of the payee, if Line 1 Line 2 Town Or Code / of levy deposite
payment payment payee payee,if available available District Pin deducted d out of
Code "Amoun
t of Levy
Acknowledgement Number:594797990301223
deducte
d"

No records added

iv. Fringe benefit tax under sub-clause (ic) ₹0

v. Wealth tax under sub-clause (iia) ₹0

vi. Royalty, license fee, service fee etc. under sub-clause (iib) ₹0

vii. Salary payable outside India/to a non resident without TDS etc. under sub-clause (iii)

Sl. Date of Amount of Name of Permanent Account Number of the Aadhaar Number of the Address Address City Or Town Zip Code / Country State
No. payment payment the payee payee,if available payee, if available Line 1 Line 2 Or District Pin Code

No records added

viii. Payment to PF /other fund etc. under sub-clause (iv) ₹0

ix. Tax paid by employer for perquisites under sub-clause (v) ₹0

(c). Amounts debited to profit and loss account being, interest, salary, bonus, commission or remuneration inadmissible under
section 40(b)/40(ba) and computation thereof;

Sl. No. Particulars Section Amount debited to P/L A/C Amount admissible Amount inadmissible Remarks

No records added

(d). Disallowance/deemed income under section 40A(3):

A. On the basis of the examination of books of account and other relevant documents/evidence, whether the expenditure covered Yes
under section 40A(3) read with rule 6DD were made by account payee cheque drawn on a bank or account payee bank draft. If
not, please furnish the details ?

Sl. Date of Nature of Name of the Permanent Account Number of the Aadhaar Number of the payee,
Amount
No. Payment Payment payee payee, if available if available

No records added

B. On the basis of the examination of books of account and other relevant documents/evidence, whether payment referred to in Yes
section 40A(3A) read with rule 6DD were made by account payee cheque drawn on a bank or account payee bank draft. If not,
please furnish the details of amount deemed to be the profits and gains of business or profession under section 40A(3A) ?

Sl. Date of Nature of Name of the Permanent Account Number of the Aadhaar Number of the payee,
Amount
No. Payment Payment payee payee, if available if available

No records added

(e). Provision for payment of gratuity not allowable under section 40A(7); ₹0

(f). Any sum paid by the assessee as an employer not allowable under section 40A(9); ₹0

(g). Particulars of any liability of a contingent nature;

Sl. No. Nature of Liability Amount

No records added

(h). Amount of deduction inadmissible in terms of section 14A in respect of the expenditure incurred in relation to income which
does not form part of the total income;

Sl. No. Particulars Amount

No records added

(i). Amount inadmissible under the proviso to section 36(1)(iii). ₹0

Acknowledgement Number:594797990301223

22. Amount of interest inadmissible under section 23 of the Micro, Small and Medium Enterprises Development Act, 2006. ₹0

23. Particulars of any payments made to persons specified under section 40A(2)(b).

Sl. Name of Related PAN of Related Aadhaar Number of the related person, if Nature of Payment
Relation
No. Person Person available Transaction Made

No records added

24. Amounts deemed to be profits and gains under section 32AC or 32AD or 33AB or 33AC or 33ABA.

Sl. No. Section Description Amount

No records added

25. Any Amount of profit chargeable to tax under section 41 and computation thereof.

Sl. No. Name of person Amount of income Section Description of Transaction Computation if any

No records added

26.i. In respect of any sum referred to in clause (a),(b),(c),(d),(e),(f) or (g) of section 43B, the liability for which:-

A. pre-existed on the first day of the previous year but was not allowed in the assessment of any preceding previous year and was

a. paid during the previous year;

Sl. No. Section Nature of liability Amount

₹0

b. not paid during the previous year;

Sl. No. Section Nature of liability Amount

₹0

B. was incurred in the previous year and was

a. paid on or before the due date for furnishing the return of income of the previous year under section 139(1);

Sl. No. Section Nature of liability Amount

1 Sec 43B(a)- tax,duty,cess,fee etc TDS Payable ₹ 3,09,688

2 Sec 43B(b)-provident/superannuation/gratuity/other fund EPF Payable ₹ 1,07,028

3 Sec 43B(b)-provident/superannuation/gratuity/other fund ESI Payable ₹ 5,963

b. not paid on or before the aforesaid date.

Sl. No. Section Nature of liability Amount

₹0
Acknowledgement Number:594797990301223

State whether sales tax,goods & services Tax, customs duty, excise duty or any other indirect tax,levy,cess,impost etc.is passed No
through the profit and loss account ?

27.a. Amount of Central Value Added Tax Credits/ Input Tax Credit(ITC) availed of or utilised during the previous year and its No
treatment in profit and loss account and treatment of outstanding Central Value Added Tax Credits/Input Tax Credit(ITC) in
accounts.

CENVAT /ITC Amount Treatment in Profit & Loss/Accounts

Opening Balance ₹0

Credit Availed ₹0

Credit Utilized ₹0

Closing /Oustanding Balance ₹0

b. Particulars of income or expenditure of prior period credited or debited to the profit and loss account.

Sl. No. Type Particulars Amount Prior period to which it relates (Year in yyyy-yy format)

No records added

28. Whether during the previous year the assessee has received any property, being share of a company not being a company in No
which the public are substantially interested, without consideration or for inadequate consideration as referred to in section 56(2)
(viia) ?

Please furnish the details of the same

Sl. Name of the PAN of the Aadhaar Name of the CIN of the No. of Amount of Fair Market
No. person from person, if Number of the company whose company Shares consideration value of the
which shares available payee, if shares are Received paid shares
received available received

No records added

29. Whether during the previous year the assessee received any consideration for issue of shares which exceeds the fair market Not Applicable
value of the shares as referred to in section 56(2) (viib) ?

Please furnish the details of the same

Sl. Name of the person from whom PAN of the Aadhaar Number of No. of Amount of Fair Market
No. consideration received for issue of person, if the payee, if shares consideration value of the
shares available available issued received shares

No records added

A.a. Whether any amount is to be included as income chargeable under the head 'income from other sources' as referred to in No
clause (ix) of sub-section (2) of section 56 ?

b. Please furnish the following details:

Sl. No. Nature of income Amount

No records added
Acknowledgement Number:594797990301223

B.a. Whether any amount is to be included as income chargeable under the head 'income from other sources' as referred to in No
clause (x) of sub-section (2) of section 56 ?

b. Please furnish the following details:

Sl. No. Nature of income Amount

No records added

30. Details of any amount borrowed on hundi or any amount due thereon (including interest on the amount borrowed) repaid, No
otherwise than through an account payee cheque. [Section 69D]

Sl. Name of the PAN of the Aadhaar Address Address City Or Zip Country State Amount Date of Amount Amount Dat
No. person from person, if Number of Line 1 Line 2 Town Or Code / borrowed borrowing due repaid e of
whom amount available the person, if District Pin including Rep
borrowed or available Code interest ay
repaid on hundi me
nt

No records added

A.a. Whether Primary adjustment to transfer price, as referred to in sub-section (1) of section 92CE, has been made during the No
previous year ?

b. Please furnish the following details:

Sl. Under which clause Amount (in Whether the excess money If yes, whether the If no, the amount (in Rs.) Expected date
No. of sub-section (1) of Rs.) of available with the associated excess money has of imputed interest of repatriation
section 92CE primary enterprise is required to be been repatriated income on such excess of money
primary adjustment adjustment repatriated to India as per the within the money which has not
is made ? provisions of sub-section (2) prescribed time ? been repatriated within
of section 92CE ? the prescribed time

No records added

B.a. Whether the assessee has incurred expenditure during the previous year by way of interest or of similar nature exceeding one No
crore rupees as referred to in sub-section (1) of section 94B ?

b. Please furnish the following details

Sl. Amount of Earnings before Amount of expenditure Details of interest expenditure Details of interest expenditure
No. expenditure by interest,tax, by way of interest or of brought forward as per sub- carried forward as per sub-
way of interest or depreciation and similar nature as per (i) section (4) of section 94B.(iv) section (4) of section 94B.(v)
of similar nature amortization above which exceeds
incurred(i) (EBITDA) during the 30% of EBITDA as per (ii)
previous year(ii) above.(iii) Assessment Amount Assessment Amount
Year Year

No records added

C.a. Whether the assessee has entered into an impermissible avoidance arrangement, as referred to in section 96, during the No
previous year ?

b. Please furnish the following details

Sl. Nature of the impermissible avoidance Amount of tax benefit in the previous year arising, in aggregate, to all the parties to the
No. arrangement arrangement

No records added

31.a.Particulars of each loan or deposit in an amount exceeding the limit specified in section 269SS taken or accepted during the previous year :-

Sl. Name of Address Permanent Aadhaar Amount Whether the Maximum Whether the In case the
No. the lender of the Account Number of of loan or loan/deposit amount loan or loan or
Acknowledgement Number:594797990301223

or lender or Number (if the lender deposit was squared outstanding deposit was deposit was
depositor depositor available or taken or up during the in the taken or taken or
with the depositor, accepted previous year account at accepted by accepted by
assessee) of if available ? any time cheque or cheque or
the lender or during the bank draft or bank draft,
depositor previous year use of whether the
electronic same was
clearing taken or
system accepted by
through a an account
bank account payee cheque
? or an account
payee bank
draft.

No records added

b.Particulars of each specified sum in an amount exceeding the limit specified in section 269SS taken or accepted during the previous year:-

Sl. Name of Address Permanent Account Aadhaar Amount Whether the specified In case the specified sum was
No. the of the Number (if available Number of of sum was taken or taken or accepted by cheque or
person person with the assessee) the person specified accepted by cheque or bank draft, whether the same
from from of the person from from whom sum bank draft or use of was taken or accepted by an
whom whom whom specified specified sum taken or electronic clearing account payee cheque or an
specified specified sum is received is received, if accepted system through a bank account payee bank draft.
sum is sum is available account ?
received received

No records added

Note: Particulars at (a) and (b) need not be given in the case of a Government company, a banking company or a corporation established by a Central, State or Provincial Act.

b.(a). Particulars of each receipt in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single transaction or in
respect of transactions relating to one event or occasion from a person, during the previous year, where such receipt is otherwise than by a cheque or bank draft or use of
electronic clearing system through a bank account

Permanent Account Number (if

Sl. Name of Address of Aadhaar Number of Nature of Amount of Date of
available with the assessee) of the
No. the payer the payer the payer, if available transaction receipt receipt
payer

No records added

b.(b). Particulars of each receipt in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single transaction or in
respect of transactions relating to one event or occasion from a person, received by a cheque or bank draft, not being an account payee cheque or an account payee bank
draft, during the previous year:-

Sl. Name of the Address of the Permanent Account Number (if available with the Aadhaar Number of the payer, Amount of
No. payer payer assessee) of the payer if available receipt

No records added

b.(c). Particulars of each payment made in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single
transaction or in respect of transactions relating to one event or occasion to a person, otherwise than by a cheque or bank draft or use of electronic clearing system
through a bank account during the previous year

Permanent Account Number (if

Sl. Name of Address of Aadhaar Number of Nature of Amount of Date of
available with the assessee) of the
No. the payee the payee the payee, if available transaction payment payment
payee

No records added

b.(d). Particulars of each payment made in an amount exceeding the limit specified in section 269ST, in aggregate from a person in a day or in respect of a single
transaction or in respect of transactions relating to one event or occasion to a person, made by a cheque or bank draft, not being an account payee cheque or an account
payee bank draft, during the previous year

Sl. Name of the Address of the Permanent Account Number (if available with the Aadhaar Number of the payee, Amount of
No. payee payee assessee) of the payee if available payment

No records added
Acknowledgement Number:594797990301223

Note: Particulars at (ba), (bb), (bc) and (bd) need not be given in the case of receipt by or payment to a Government company, a banking Company, a post office savings bank, a
cooperative bank or in the case of transactions referred to in section 269SS or in the case of persons referred to in Notification No. S.O. 2065(E) dated 3rd July, 2017

c. Particulars of each repayment of loan or deposit or any specified advance in an amount exceeding the limit specified in section 269T made during the previous year:-

Sl. Name Address Permanent Aadhaar Amount of Maximum amount Whether the In case the repayment
No. of the of the Account Number of repayment outstanding in repayment was was made by cheque
payee payee Number (if the payee, the account at made by cheque or or bank draft, whether
available with if available any time during bank draft or use of the same was repaid
the assessee) the previous year electronic clearing by an account payee
of the payee system through a cheque or an account
bank account ? payee bank draft.

No records added

d. Particulars of repayment of loan or deposit or any specified advance in an amount exceeding the limit specified in section 269T received otherwise than by a cheque or
bank draft or use of electronic clearing system through a bank account during the previous year:-

Amount of repayment of loan or deposit or any specified

Name of Permanent Account Aadhaar Number
Sl. Address of advance received otherwise than by a cheque or bank draft or
the Number (if available with of the payer, if
No. the payer use of electronic clearing system through a bank account
payer the assessee) of the payer available
during the previous year

No records added

e. Particulars of repayment of loan or deposit or any specified advance in an amount exceeding the limit specified in section 269T received by a cheque or bank draft which
is not an account payee cheque or account payee bank draft during the previous year:-

Amount of repayment of loan or deposit or any specified

Name of Permanent Account Number Aadhaar Number
Sl. Address of advance received by a cheque or bank draft which is not an
the (if available with the of the payer, if
No. the payer account payee cheque or account payee bank draft during the
payer assessee) of the payer available
previous year

No records added

Note: Particulars at (c), (d) and (e) need not be given in the case of a repayment of any loan or deposit or specified advance taken or accepted from Government, Government
company, banking company or a corporation established by a Central, State or Provincial Act

32.a. Details of brought forward loss or depreciation allowance, in the following manner, to the extent available

Amount as Amount as adjusted by Amount as

returned (if the withdrawal of additional assessed (give
All
assessed depreciation on account of reference to
losses/allowances
Sl. Assessment Nature of depreciation is opting for taxation under relevant order)
not allowed under Remarks
No. Year loss/allowance less and no section
section 115BAA /
appeal pending 115BAC/115BAD(To be Order
115BAC / 115BAD
then take filled in for assessment Amount U/s &
assessed) year 2021-22 only) Date

No records added

b. Whether a change in share holding of the company has taken place in the previous year due to which the losses incurred prior Not Applicable
to the previous year cannot be allowed to be carried forward in terms of section 79 ?

c. Whether the assessee has incurred any speculation loss referred to in section 73 during the previous year ? No

If yes, please furnish the details of the same. ₹0

d. Whether the assessee has incurred any loss referred to in section 73A in respect of any specified business during the previous No
year ?

If yes, please furnish the details of the same. ₹0

e. In case of a company, please state that whether the company is deemed to be carrying on a speculation business as referred in Not Applicable
explanation to section 73.

If yes, please furnish the details of the same. ₹0

33. Section-wise details of deductions, if any admissible under Chapter VIA or Chapter III (Section 10A, Section 10AA). No
Acknowledgement Number:594797990301223

Amounts admissible as per the provision of the Income-tax Act,1961 and fulfils the conditions, if any, specified under
Sl. Section under which
the relevant provisions of Income-tax Act, 1961 or Income-tax Rules, 1962 or any other guidelines, circular, etc, issued
No. deduction is claimed
in this behalf.

No records added

34.(a). Whether the assessee is required to deduct or collect tax as per the provisions of Chapter XVII-B or Chapter XVII-BB, Yes
please furnish ?

Sl. (1)Tax (2)Sectio (3)Nature of (4)Total (5)Total (6)Total (7)Amount (8)Total (9)Amount (10)Amount
No. deduction n payment amount of amount on amount on of tax amount of tax of tax
and payment or which tax which tax deducted on which deducted deducted or
collection receipt of the was required was or tax was or collected
Account nature to be deducted or collected deducted collected not
Number specified in deducted or collected at out of (6) or on (8) deposited
(TAN) column (3) collected out specified collected to the credit
of (4) rate out of at less of the
(5) than Central
specified Government
rate out out of (6)
of (7) and (8) (10)

1 DELA48950G 192 Salary ₹2,81,52,780 ₹2,81,52,780 ₹2,81,52,780 ₹9,45,180 ₹0 ₹0 ₹0

2 DELA48950G 194C Payments ₹4,36,22,604 ₹4,36,22,604 ₹4,36,22,604 ₹4,50,770 ₹0 ₹0 ₹0

to
contractors

3 DELA48950G 194H Commission ₹1,76,070 ₹1,76,070 ₹1,76,070 ₹8,804 ₹0 ₹0 ₹0

or
brokerage

4 DELA48950G 194J Fees for ₹48,06,769 ₹48,06,769 ₹48,06,769 ₹4,18,777 ₹0 ₹0 ₹0

professional
or technical
services

5 DELA48950G 195 Other sums ₹35,705 ₹35,705 ₹35,705 ₹7,429 ₹0 ₹0 ₹0

(b). Whether the assessee is required to furnish the statement of tax deducted or tax collected ? Yes

Please furnish the details:

Sl. Tax deduction and Type Due date Date of Whether the statement of tax deducted or collected Please furnish list of
No. collection Account of for furnishing, contains information about all details/transactions details/transactions
Number (TAN) Form furnishing if which are required to be reported which are not reported.
furnished

1 DELA48950G 24Q 31-Jul- 18-Jul-2022 Yes

2022

2 DELA48950G 24Q 31-Oct- 22-Oct- Yes

2022 2022

3 DELA48950G 24Q 31-Jan- 24-Jan- Yes

2023 2023

4 DELA48950G 24Q 31-May- 29-May- Yes

2023 2023

5 DELA48950G 26Q 31-Jul- 18-Jul-2022 Yes

2022

6 DELA48950G 26Q 30-Nov- 22-Oct- Yes

2022 2022

7 DELA48950G 26Q 31-Jan- 24-Jan- Yes

2023 2023

8 DELA48950G 26Q 31-May- 25-May- Yes

2023 2023

9 DELA48950G 27Q 31-Jul- 18-Jul-2022 Yes

2022
Acknowledgement Number:594797990301223

10 DELA48950G 27Q 31-Oct- 22-Oct- Yes

2022 2022

11 DELA48950G 27Q 31-May- 29-May- Yes

2023 2023

(c). Whether the assessee is liable to pay interest under section 201(1A) or section 206C(7) ? Yes

Please furnish:

Sl. Tax deduction and collection Account Amount of interest under section Amount paid out of column (2) along with date
No. Number (TAN)(1) 201(1A)/206C(7) is payable(2) of payment.(3)

Amount Date of payment

1 DELA48950G ₹0 ₹ 1,290 07-Jun-2022

2 DELA48950G ₹0 ₹ 188 07-Jul-2022

3 DELA48950G ₹0 ₹ 34 07-Sep-2022

4 DELA48950G ₹0 ₹ 2,032 07-Oct-2022

5 DELA48950G ₹0 ₹ 4,994 07-Dec-2022

6 DELA48950G ₹0 ₹ 250 07-Jan-2023

7 DELA48950G ₹0 ₹ 7,501 07-Mar-2023

8 DELA48950G ₹0 ₹ 12,047 24-May-2023

9 DELA48950G ₹0 ₹ 3,125 27-May-2023

35.(a). In the case of a trading concern, give quantitative details of prinicipal items of goods traded;

Sl. Item Unit Opening Purchases during the Sales during the Closing Shortage/excess, if
No. Name Name stock pervious year pervious year stock any

No records added

(b). In the case of manufacturing concern,give quantitative details of the prinicipal items of raw materials, finished products and by-products.

A. Raw materials:

Purchases Sales
Consumption Yield of
Sl. Item Unit Opening during the during the Closing Percentage Shortage/excess,
during the finished
No. Name Name stock pervious pervious stock of yield if any
pervious year products
year year

No records added

B. Finished products :

Sl. Item Unit Opening Purchases during Quantity manufactured Sales during the Closing Shortage/excess, if
No. Name Name stock the pervious year during the pervious year pervious year stock any

No records added

C. By-products

Sl. Item Unit Opening Purchases during Quantity manufactured Sales during the Closing Shortage/excess, if
No. Name Name stock the pervious year during the pervious year pervious year stock any

No records added
Acknowledgement Number:594797990301223

36.(a). Whether the assessee has received any amount in the nature of dividend as referred to in sub-clause (e) of clause (22) of No
section 2 ?
Please furnish the following details:-

Sl. No. Amount received Date of receipt

No records added

37. Whether any cost audit was carried out ? Not Applicable

Give the details, if any, of disqualification or disagreement on any matter/item/value/quantity as may be reported/identified by the
cost auditor

38. Whether any audit was conducted under the Central Excise Act, 1944 ? No

Give the details, if any, of disqualification or disagreement on any matter/item/value/quantity as may be reported/identified by the
auditor.

39. Whether any audit was conducted under section 72A of the Finance Act, 1994 in relation to valuation of taxable services as No
may be reported/identified by the auditor. ?

give the details, if any, of disqualification or disagreement on any matter/item/value/quantity as may be reported/identified by the
auditor.

40. Details regarding turnover, gross profit, etc., for the previous year and preceding previous year:

Sl. No. Particulars Previous Year % Preceding previous Year %

(a) Total turnover of the assessee 5026023 835351055

(b) Gross profit / Turnover 1451198 5026023 28.87 250071599 835351055 29.94

(c) Net profit / Turnover 2227265 5026023 44.31 48320319 835351055 5.78

(d) Stock-in-Trade / Turnover 0 5026023 0.00 508000 835351055 0.06

(e) Material consumed / Finished goods produced 0 0 0.00 0 0 0.00

41. Please furnish the details of demand raised or refund issued during the previous year under any tax laws other than Income-tax Act, 1961 and Wealth-tax Act, 1957
alongwith details of relevant proceedings.

Sl. Financial year to which Name of other Type (Demand Date of demand
Amount Remarks
No. demand/refund relates to Tax law raised/Refund received) raised/refund received

No records added

42.a. Whether the assessee is required to furnish statement in Form No.61 or Form No. 61A or Form No. 61B ? No

b. Please furnish
Acknowledgement Number:594797990301223

Whether the Form contains

Income-tax Department Type Date of If not, please furnish list of the
Sl. Due date for information about all details/
Reporting Entity of furnishing, if details/transactions which are
No. furnishing furnished transactions which are
Identification Number Form furnished not reported.
required to be reported ?

No records added

43.a. Whether the assessee or its parent entity or alternate reporting entity is liable to furnish the report as referred to in sub- No
section (2) of section 286 ?

b. Please furnish the following details:

Whether report has been furnished by the assessee or its parent entity or an alternate reporting entity?

Name of parent entity

Name of alternate reporting entity (if applicable)

Date of furnishing of report

c.Please enter expected date of furnishing the report

44. Break-up of total expenditure of entities registered or not registered under the GST.

Sl. Total amount of Expenditure in respect of entities registered under GST Expenditure relating to
No. Expenditure incurred entities not registered
during the year Relating to goods Relating to entities Relating to other Total payment to under GST
or services exempt falling under registered registered
from GST composition scheme entities entities

No records added

Accountant Details

Accountant Details

Name KAVITA KUMARI

Membership Number 549975

FRN(Firm Registration Number) 0033238N

Address B-172, Rajeev Gandhi Colony , Transit Camp,

Govind Puri, Kalkaji , 09-Delhi , 91-India , Pincode -
110019

Place 43.248.153.207

Date 29-Dec-2023

Additions Details (From Point No.18)

Description of the Sl. Date of Date Purchase Adjustments on Account of Total Value of
Block of No. Purchase put to Value(1) Purchases(B)
Assets/Class of Use subsidy or grant or (1+2+3+4)
Change in
Assets reimbursement, by
CENVAT(2) Rate of
whatever name called
Exchange (3)
(4)

Furnitures & Fittings No records added

@ 10%

Description of the Sl. Date of Date Purchase Adjustments on Account of Total Value of
Block of No. Purchase put to Value(1) Purchases(B)
Use (1+2+3+4)
Acknowledgement Number:594797990301223

Assets/Class of
subsidy or grant or
Assets Change in
reimbursement, by
CENVAT(2) Rate of
whatever name called
Exchange (3)
(4)

Plant and Machinery 1 01-Apr- 01- ₹ ₹0 ₹0 ₹0 ₹ 35,00,000

@ 15% 2022 Apr- 35,00,000
2022

2 18-Jan- 18- ₹ 42,397 ₹0 ₹0 ₹0 ₹ 42,397

2023 Jan-
2023

3 03-Sep- 03- ₹ 1,90,000 ₹0 ₹0 ₹0 ₹ 1,90,000

2022 Sep-
2022

4 12-Aug- 12- ₹ 80,000 ₹0 ₹0 ₹0 ₹ 80,000

2022 Aug-
2022

Description of the Sl. Date of Date Purchase Adjustments on Account of Total Value of
Block of No. Purchase put to Value(1) Purchases(B)
Assets/Class of Use subsidy or grant or (1+2+3+4)
Change in
Assets reimbursement, by
CENVAT(2) Rate of
whatever name called
Exchange (3)
(4)

Plant and Machinery 1 13-Oct- 13- ₹ 76,195 ₹0 ₹0 ₹0 ₹ 76,195

@ 40% 2022 Oct-
2022

Description of the Sl. Date of Date Purchase Adjustments on Account of Total Value of
Block of No. Purchase put to Value(1) Purchases(B)
Assets/Class of Use subsidy or grant or (1+2+3+4)
Change in
Assets reimbursement, by
CENVAT(2) Rate of
whatever name called
Exchange (3)
(4)

Plant and Machinery No records added

@ 30%

Deductions Details (From Point No.18)

Description of the Block of Assets/Class of Sl. Date of Whether deletions are out of purchases put to use for less than
Amount
Assets No. Sale 180 days

Furnitures & Fittings @ 10% No records added

Description of the Block of Assets/Class of Sl. Date of Whether deletions are out of purchases put to use for less than
Amount
Assets No. Sale 180 days

Plant and Machinery @ 15% No records added

Description of the Block of Assets/Class of Sl. Date of Whether deletions are out of purchases put to use for less than
Amount
Assets No. Sale 180 days

Plant and Machinery @ 40% No records added

Description of the Block of Assets/Class of Sl. Date of Whether deletions are out of purchases put to use for less than
Amount
Assets No. Sale 180 days

Plant and Machinery @ 30% No records added

This form has been digitally signed by KAVITA KUMARI having PAN CNOPK7627N from IP Address 43.248.153.207 on 30/12/2023 04:06:26 PM Dsc Sl.No and issuer
,C=IN,O=Verasys Technologies Pvt Ltd.,OU=Certifying Authority
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period April

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB090423605125H
2(d). Date of ARN 20/05/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
38810.00

0.00
0.00
0.00
0.00
tax
6310.80

-
0.00

0.00
tax

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
-
-

-
0.00

0.00
tax

-
-

-
0.00

0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 36810.00 6040.80
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 0.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 162505.65 27495.87 27495.87 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 162505.65 27495.87 27495.87 0.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax

-
ED
0.01

0.01
Central tax
-

0.00
25.00
State/UT tax
-

0.00
25.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 6311.00 6311.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 0.00 0.00 0.00 - - 0.00 0.00 25.00
State/UT tax 0.00 0.00 - 0.00 - 0.00 0.00 25.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

April 2023 6311.00 0.00 0.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/05/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period May

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB090523835319W
2(d). Date of ARN 20/06/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
399948.37

0.00
0.00
0.00
0.00
tax
71765.71

-
0.00

0.00
tax

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
-
-

-
0.00

0.00
tax

-
-

-
0.00

0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 399948.37 71765.71
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 0.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 96049.57 30476.40 30476.40 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 96049.57 30476.40 30476.40 0.00
(D) Other Details 0.00 5619.00 5619.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 5619.00 5619.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 71766.00 71766.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 0.00 0.00 0.00 - - 0.00 0.00 0.00
State/UT tax 0.00 0.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

May 2023 71766.00 0.00 0.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/06/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period June

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AC090623375195T
2(d). Date of ARN 20/07/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
484341.00

0.00
0.00
0.00
0.00
tax
81151.38

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
1665.00

-
-

-
0.00
tax
1665.00

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 452981.00 79061.58
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 291191.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 120.60 6.50 6.50 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 271345.70 53704.18 53704.18 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 562657.30 53710.68 53710.68 0.00
(D) Other Details 0.00 4881.36 4881.36 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 4881.36 4881.36 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 81151.00 81151.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 1665.00 1665.00 0.00 - - 0.00 0.00 0.00
State/UT tax 1665.00 1665.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

June 2023 81151.00 1665.00 1665.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/07/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period July

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB090723469691O
2(d). Date of ARN 19/08/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
529020.00

900000.00

50000.00
0.00

0.00
tax
64338.60

-
2500.00
-
0.00
tax

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
-
-

-
0.00

0.00
tax

-
-

-
0.00

0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 22500.00 2700.00
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 0.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 129981.55 25187.91 25187.91 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 125.00
C. Net ITC available (A-B) 129981.55 25187.91 25187.91 -125.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 64339.00 64339.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 0.00 0.00 0.00 - - 0.00 0.00 0.00
State/UT tax 0.00 0.00 - 0.00 - 0.00 0.00 0.00
Cess 125.00 - - - 125.00 0.00 0.00 -
(B) Reverse charge
Integrated 2500.00 - - - - 2500.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

July 2023 66839.00 0.00 0.00 125.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 19/08/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period August

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB090823511090H
2(d). Date of ARN 19/09/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
1846387.16

0.00
0.00
0.00
0.00
tax
152150.83

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
1485.00

-
-

-
0.00
tax
1485.00

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 297100.00 53478.00
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 17229.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 171004.47 87487.72 87487.72 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 188233.47 87487.72 87487.72 0.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 152151.00 152151.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 1485.00 1485.00 0.00 - - 0.00 0.00 0.00
State/UT tax 1485.00 1485.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

August 2023 152151.00 1485.00 1485.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 19/09/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period September

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB090923459828B
2(d). Date of ARN 17/10/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
21800.00

600000.00
0.00
0.00
0.00
tax
3429.00

-
0.00

0.00
tax

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
-
-

-
0.00

0.00
tax

-
-

-
0.00

0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 16780.00 2120.40
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 47531.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 280790.41 92496.02 92496.02 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 328321.41 92496.02 92496.02 0.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 3429.00 3429.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 0.00 0.00 0.00 - - 0.00 0.00 0.00
State/UT tax 0.00 0.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

September 2023 3429.00 0.00 0.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 17/10/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period October

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB091023711067J
2(d). Date of ARN 20/11/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
500000.00

0.00
0.00
0.00
0.00
tax
60570.00

-
0.00

0.00
tax

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
135.00

-
-

-
0.00
tax
135.00

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 0.00 0.00
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 81454.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 122584.10 32720.93 32720.93 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 10872.91 4379.64 4379.64 0.00
C. Net ITC available (A-B) 193165.19 28341.29 28341.29 0.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 60570.00 60570.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 135.00 135.00 0.00 - - 0.00 0.00 0.00
State/UT tax 135.00 135.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

October 2023 60570.00 135.00 135.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/11/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period November

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB091123436202N
2(d). Date of ARN 19/12/2023

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
1794624.00

65875.00
0.00
0.00
0.00
tax
165275.10

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
26785.74

-
-

-
0.00
tax
26785.74

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 1348195.00 165275.10
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 4796.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 134027.01 11269.08 11269.08 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 80497.49 0.00 0.00 0.00
C. Net ITC available (A-B) 58325.52 11269.08 11269.08 0.00
(D) Other Details 0.00 2051.83 2051.83 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 2051.83 2051.83 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 165275.00 165275.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 26786.00 26786.00 0.00 - - 0.00 0.00 0.00
State/UT tax 26786.00 26786.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

November 2023 165275.00 26786.00 26786.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 19/12/2023 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period December

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB0912238471555
2(d). Date of ARN 18/01/2024

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
2773955.00

0.00
0.00
0.00
0.00
tax
291567.60

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
28257.15

-
-

-
0.00
tax
28257.15

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 228320.00 40767.60
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 73591.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 34415.89 151234.71 151234.71 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 31012.72 106403.57 106403.57 0.00
C. Net ITC available (A-B) 76994.17 44831.14 44831.14 0.00
(D) Other Details 0.00 132.00 132.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 132.00 132.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 291568.00 291568.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 28257.00 28257.00 0.00 - - 0.00 0.00 0.00
State/UT tax 28257.00 28257.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

December 2023 291568.00 28257.00 28257.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 18/01/2024 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period January

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB0901248561464
2(d). Date of ARN 20/02/2024

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
3435063.67

0.00
0.00
0.00
0.00
tax
372501.32

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
26785.71

-
-

-
0.00
tax
26785.71

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 806135.10 110601.32
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 434629.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 89750.16 65999.93 65999.93 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 524379.16 65999.93 65999.93 0.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 372501.00 372501.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 26786.00 26786.00 0.00 - - 0.00 0.00 0.00
State/UT tax 26786.00 26786.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

January 2024 372501.00 26786.00 26786.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/02/2024 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period February

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AB090224786193Y
2(d). Date of ARN 20/03/2024

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
1571833.90

600000.00
0.00
0.00
0.00
tax
82049.22

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
55446.43

-
-

-
0.00
tax
55446.43

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 505692.86 60683.14
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 418416.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 109851.87 83919.24 83919.24 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 0.00 0.00 0.00 0.00
C. Net ITC available (A-B) 528267.87 83919.24 83919.24 0.00
(D) Other Details 0.00 0.00 0.00 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 0.00 0.00 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 82049.00 82049.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 55446.00 55446.00 0.00 - - 0.00 0.00 0.00
State/UT tax 55446.00 55446.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

February 2024 82049.00 55446.00 55446.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/03/2024 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 Form GSTR-3B
[See rule 61(5)]

Year 2023-24
Period March

GSTIN of the supplier 09ABLFA3988M1ZL

2(a). Legal name of the registered person AgVa Healthcare
2(b). Trade name, if any AgVa Healthcare
2(c). ARN AC0903244303575
2(d). Date of ARN 20/04/2024

(Amount in ₹ for all tables)

3.1 Details of Outward supplies and inward supplies liable to reverse charge (other than those covered by Table 3.1.1)

Nature of Supplies Total taxable Integrated Central State/UT Cess

exempted)
(b) Outward taxable supplies (zero rated)
(c ) Other outward supplies (nil rated, exempted)
(d) Inward supplies (liable to reverse charge)
(e) Non-GST outward supplies
ED
(a) Outward taxable supplies (other than zero rated, nil rated and
value
2864999.42

1500000.00
0.00
0.00
0.00
tax
290228.57

-
0.00

0.00

3.1.1 Details of Supplies notified under section 9(5) of the CGST Act, 2017 and corresponding provisions in IGST/UTGST/
tax
26785.68

-
-

-
0.00
tax
26785.68

-
-

-
0.00
0.00

0.00
-
0.00
-

SGST Acts
FIL
Nature of Supplies Total Integrated Central State/ Cess
taxable tax tax UT tax
value
(i) Taxable supplies on which electronic commerce operator pays tax u/s 9(5) [to 0.00 0.00 0.00 0.00 0.00
be furnished by electronic commerce operator]
(ii) Taxable supplies made by registered person through electronic commerce 0.00 - - - -
operator, on which electronic commerce operator is required to pay tax u/s 9(5)
[to be furnished by registered person making supplies through electronic
commerce operator]

3.2 Out of supplies made in 3.1 (a) and 3.1.1 (i), details of inter-state supplies made

Nature of Supplies Total taxable value Integrated tax

Supplies made to Unregistered Persons 890000.00 106800.00
Supplies made to Composition Taxable 0.00 0.00
Persons
Supplies made to UIN holders 0.00 0.00

4. Eligible ITC

Details Integrated tax Central tax State/UT tax Cess

A. ITC Available (whether in full or part)
(1) Import of goods 247080.00 0.00 0.00 0.00
(2) Import of services 0.00 0.00 0.00 0.00
(3) Inward supplies liable to reverse charge (other than 1 & 2 above) 0.00 0.00 0.00 0.00
 (4) Inward supplies from ISD 0.00 0.00 0.00 0.00
(5) All other ITC 127934.71 157334.99 157334.99 0.00
B. ITC Reversed
(1) As per rules 38,42 & 43 of CGST Rules and section 17(5) 0.00 0.00 0.00 0.00
(2) Others 162310.65 77773.75 77773.75 0.00
C. Net ITC available (A-B) 212704.06 79561.24 79561.24 0.00
(D) Other Details 0.00 21649.82 21649.82 0.00
(1) ITC reclaimed which was reversed under Table 4(B)(2) in earlier tax 0.00 0.00 0.00 0.00
period
(2) Ineligible ITC under section 16(4) & ITC restricted due to PoS rules 0.00 21649.82 21649.82 0.00

5 Values of exempt, nil-rated and non-GST inward supplies

Nature of Supplies Inter- State supplies Intra- State supplies

From a supplier under composition scheme, Exempt, Nil rated supply 0.00 0.00
Non GST supply 0.00 0.00

5.1 Interest and Late fee for previous tax period

Details
System computed
Interest
Interest Paid
Late fee
Integrated tax
-

-
ED
0.00
Central tax
-

0.00
0.00
State/UT tax
-

0.00
0.00
Cess
-

-
0.00
FIL
6.1 Payment of tax

Description Total tax Tax paid through ITC Tax paid in Interest paid Late fee
payable cash in cash paid in cash
Integrated tax Central tax State/UT tax Cess
(A) Other than reverse charge
Integrated 290229.00 290229.00 0.00 0.00 - 0.00 0.00 -
tax
Central tax 26786.00 26786.00 0.00 - - 0.00 0.00 0.00
State/UT tax 26786.00 26786.00 - 0.00 - 0.00 0.00 0.00
Cess 0.00 - - - 0.00 0.00 0.00 -
(B) Reverse charge
Integrated 0.00 - - - - 0.00 - -
tax
Central tax 0.00 - - - - 0.00 - -
State/UT tax 0.00 - - - - 0.00 - -
Cess 0.00 - - - - 0.00 - -

Breakup of tax liability declared (for interest computation)

Period Integrated tax Central tax State/UT tax Cess

March 2024 290229.00 26786.00 26786.00 0.00

Verification:
I hereby solemnly affirm and declare that the information given herein above is true and correct to the best of my knowledge and belief and
nothing has been concealed there from.
Date: 20/04/2024 Name of Authorized Signatory
Diwakar Vaish

Designation /Status
PARTNER

ED
FIL
 AgVa

Annexure V
Declaration from existing CMS approved Bidders about supply of 80 % over ordered quantity made for each item
during the period from 01-10-2023 to 30-09-2024 limited to requirement for the period based on annual
requirement of the item / items of the State projected through STORE MANAGEMENT INFORMATION
SYSTEM as on the date of submission of tender

Sn CMS Name of the Ordered quantity as per Total GRN made % of GRN over
vendor portal during the
Catalogue item against the order quantity
period from 01.04.2023 to
No order(s) placed as on
31.03.2024
during the period submission of
from 01.04.2023 tender
to 30.06.2024

Not Applicable

A-1 SECTOR 83 NOIDA

+91-73 30 40 50 60 WWW.AGVAHEALTHTECH.COM
[email protected] UP 201301 (INDIA)
 FORM MD-9

[See sub-rule (1) rule 25]

Licence to Manufacture for Sale or for Distribution of Class C or Class D medical device

Licence Number: MFG/MD/2024/000178

1. M/s AgVa Healthcare, A01, Sector 83 Block A Road, NOIDA, Gautam Buddha Nagar, Uttar Pradesh, 201301Noida,
Gautam Buddha Nagar, Uttar Pradesh (India) - 201301 Telephone No.: 9311337770 FAX: 9311337770 has been
licenced to manufacture for sale or for distribution the below listed medical device(s) at the premises situated at M/s
AgVa Healthcare, A01, Sector 83 Block A Road, NOIDA, Gautam Buddha Nagar, Uttar Pradesh, 201301, Gautam
Buddha Nagar, Uttar Pradesh (India) - 201301 Telephone No.: 7011803119 FAX: 7011803119

2. Details of medical device(s) [Annexed]

3. The names, qualifications and experience of the competent technical staff responsible for the manufacture and
testing of the above mentioned medical device(s): As per records maintain by the manufacturer

4. This licence is subject to the provisions of the Medical Devices Rules, 2017 and conditions prescribed therein.

ANNEXURE
S.No. Details Of Device(s)
Generic Name:Ventilators
1 Model No.:AgVa PRO - High End Turbine & 24 inch Display
Intended Use:AgVa Ventilators is a Mechanical Ventilators Designed to Provide
Invasive & Non- Invasive , Continuous or Intermittent , Respiratory Support to
Neonatal , Paediatrics & Adults Patients
Class of medical device:Class C
Material of construction:Mild Steel , Cast Iron, Acrylic , Stainless Steel 304 ,
Aluminium HE 30 , polypropylene , PVC , Silicon , Thermoplastic Polyurethane ,
Thermoplastic Vulcanisate
Dimension(if any):1520 * 460 * 420 mm
Shelflife:Nil
Sterile or Non sterile:Non-Sterilized
Brand Name(if registered under the Trade Marks Act, 1999):AgVa Pro Digitally signed by RAJEEV SINGH RAGHUVANSHI
DN: c=IN, o=CENTRAL DRUGS STANDARD CONTROL

RAJEEV SINGH ORGANIZATION, ou=RAJEEV SINGH RAGHUVANSHI,

2.5.4.20=80c62f6a23e4eafbe8a239774cdeb03c2769
041015a06564fe67f54b765db1cb,

RAGHUVANSHI
postalCode=600034, st=TAMIL NADU,
serialNumber=657F5E47D940985D8F03BDC902D0E
1FE73CFA12A1A126EA94FA5701124A19013,
cn=RAJEEV SINGH RAGHUVANSHI
Date: 2024.03.19 16:01:42 +05'30'

Place:

Date:19-Mar-24 Central Licensing Authority

Page 1 of 1
 Government of India / भारत सरकार
Ministry of Commerce and Industry / वाणिज्य और उद्योग मंत्रालय
Directorate General of Foreign Trade / विदेश व्यापार महानिदेशालय
Office of the Additional Director General of Foreign Trade, CLA Delhi /अपर महानिदेशक, विदेश व्यापार का
कार्यालय, सीएलए दिल्ली
Central Licensing Area (CLA), A Wing I.P. Bhawan, I.P. Estate, CENTRAL DELHI, DELHI, 110002 /
केन्‍द्रीय लाइसेंसिंग क्षेत्र (सीएलए), ए विंग, आई.पी. भवन, आई.पी. एस्टेट, नई दिल्ली, मध्य दिल्ली, दिल्ली, 110002

Importer-Exporter Code

This is to certify that AGVA HEALTHCARE is issued an Importer-Exporter Code

(IEC) ABLFA3988M with details as follows -

IEC ABLFA3988M

स्थाई खाता सं.(पैन) /PAN ABLFA3988M

फर्म का नाम/Firm Name AGVA HEALTHCARE

निगम की प्रकृति /Nature of

Partnership
Concern

जारी करने की तारीख/Date of

29/05/2019
Issue
A01, Sector 83 Block A Road, NOIDA, Gautam Buddha Nagar,, , Uttar
पता/Registered Address
Pradesh, GAUTAM BUDDHA NAGAR, UTTAR PRADESH, 201301

धारक का नाम / Name of the

Diwakar Vaish
Signatory
Director / Partner Details Refer online at https://dgft.gov.in or scan the QR Code

शाखा/इकाई /Branch Details Refer online at https://dgft.gov.in or scan the QR Code

Last Modified : 07/08/2023

File Number : DLIIECPAMEND00053469AM24

Note : This is a system-generated certificate. Authenticity / Updated details of the IEC can be checked at
official DGFT website https://dgft.gov.in by entering the IEC and Firm Name under Services > View Any
IEC Details. You can also authenticate the certificate by scanning the QR code.

1
 F NO : HQ/MSC/MD/2024/000487

Government of India
Directorate General of Health Services
Central Drugs Standard Control Organisation
Ministry of Health and Family welfare
(Medical Device and Diagnostic Division)
Market Standing Certificate

Certificate Number : MSC/MD/2024/000633 Dated : 01/07/2024

This is to certify that M/s. AgVa Healthcare situated at address A01, Sector 83 Block A Road, NOIDA, Gautam
Buddha Nagar, Uttar Pradesh, 201301 ,Gautam Buddha Nagar Uttar Pradesh ,201301,7011803119, India
Gautam Buddha Nagar Uttar Pradesh 201301 7011803119 India is holding Manufacturing/Import License no.
MFG/MD/2024/000178 issued on 19-MAR-2024 Under this license, the said firm is permitted to
manufacture/import of medical devices as stated in manufacturing/import license.
Name of the products with their product name and dimensions if any mentioned below :

S.NO Medical Device Details

1. Generic Name :Ventilators
1
2. Brand Name :AgVa Pro
3. Notified Category :OthersVentilators
4. Class of Medical Device :Class C
5. Shelf life :Nil
6. Sterile/Non-Sterile:Non-Sterilized
7. Intended Use :AgVa Ventilators is a Mechanical Ventilators Designed to Provide
Invasive & Non- Invasive , Continuous or Intermittent , Respiratory Support to Neonatal ,
Paediatrics & Adults Patients
8. Material of Construction: Mild Steel , Cast Iron, Acrylic , Stainless Steel 304 ,
Aluminium HE 30 , polypropylene , PVC , Silicon , Thermoplastic Polyurethane ,
Thermoplastic Vulcanisate
9. Dimension: 1520 * 460 * 420 mm
10. Model/Catalogue No./Name :AgVa PRO - High End Turbine & 24 inch Display
Note: Validity of the Market Satanding will be 1 year from the date of issuance or till validity of licence,whichever
is earlier.

Digitally signed by RAJEEV SINGH RAGHUVANSHI

RAJEEV SINGH
DN: c=IN, o=CENTRAL DRUGS STANDARD CONTROL
ORGANISATION, ou=CENTRAL DRUGS STANDARD CONTROL
ORGANISATION,
2.5.4.20=42d7189b1c0981bb5a263a4a73d025ff4b11b680a91f
Competent Authority
RAGHUVANSHI
08773480400a43ee361b, postalCode=110002, st=Delhi,
serialNumber=657f5e47d940985d8f03bdc902d0e1fe73cfa12a
1a126ea94fa5701124a19013, cn=RAJEEV SINGH
RAGHUVANSHI
Date: 2024.07.01 17:34:17 +05'30'
 This is to Certify that the Management System of

AGVA HEALTHCARE
A01, SECTOR 83 BLOCK A ROAD, NOIDA, GAUTAM BUDDHA NAGAR,
UTTAR PRADESH – 201301, INDIA

.has been audited and found to comply with the requirements of:

ISO 13485:2016
(Medical Devices – Quality Management System)

For the Scope of activities described below:

DESIGN, DEVELOPMENT, MANUFACTURING, SALES, DISTRIBUTION AND INSTALLATION

OF ACTIVE MEDICAL DEVICES – VENTILATORS, POWERED SUCTION PUMP,
DEEP VEIN THROMBOSIS PREVENTION THERAPY SYSTEM

Certificate No.: IN96607H

Date of initial registration Date of this Certificate Surv. audit on or before/ Certificate expiry Recertification Due
15 June 2022 22 April 2023 14 June 2024 14 June 2025
Validity of this certificate is subject to successful completion of surveillance audit on or before due date,
in case surveillance audit not conducted this certificate shall be suspended/cancelled.

Director
 SAFETY TESTING LABORATORY: TEST REPORT
IEC 60601 – 1:2005+A1:2012+A2:2020
Medical Electrical Equipment
Part 1: General Requirements for Basic Safety and Essential Performance

Test Report No. : SWEN/23-24/346-02

ULR No. & Discipline : TC633023000000378P / ELECTRONICS

Job No. : 346-02

Date of Issue of Report : 26th October 2023

Date of Sample Received : 16th August 2023

Date of Testing : 16th August 2023 to 16th October 2023

Testing Location : LABORATORY / ON-SITE

SWEN KONFORMITY
Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7,
Name & Address of Testing Location : Near Chhatrapati Urban Co-op Bank, Vishal Nagar,
Pimple Nilakh, Pune-411027, Maharashtra (India))

Trademark of manufacturer :
AgVa Healthcare
Name & Address of Customer : A01, Sector 83 Block A Road, NOIDA, Gautam Buddha
Nagar, Uttar Pradesh- 201301, India.
Customer Representative : Mr. Arunkumar Chokkalingam

Sample Description : Ventilator

Condition Of Sample : OK

Model / Type / Reference : AgVa Pro

Serial No. / I.D No : A012306013

Ratings : (110 ± 10) V a.c., 4A; (230 ± 10) V a.c.,3A; 50/60Hz

Test Method (Type/Routine/Verification) : Type

Ambient Temperature & Humidity : (24.8– 27.8) °C & (51 -60) % RH

Atmospheric pressure and Altitude : 945 hPa & 560 m

Remarks: This report is governed by and incorporates by reference; the condition of testing as posted as its date of issuance and is intended
for your exclusive use. Any copying or replication of this report to or for any other person entity, or use of our name or logo, is permitted
only with our prior written permission. This report sets forth solely our findings with respect to the test samples identified herein. It
includes all of the tests and all results thereof based upon the information that you provided us with. You have 10 calendar days from the
date of issuance of this report to notify us of any material error or omission; provided, however, that such notice shall be written and shall
specifically address the issue you wish to raise. A failure to raise such an issue within the prescribed time shall constitute your unqualified
acceptance of the completeness of this report, the tests conducted and the correctness of the report contents. The test report can also be
received from the website: www.swenlab.com. Annex-A of this test report is as per NABL accredited scope.

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 1 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Possible test case verdicts:

• Test does not apply to the test object………………………………………….: N/A.

• Information not available…………………………………………………………..: N/AV
• Test object meets the requirement………………………………………………: Conforming.
• Test object does not meet the requirement………………………………….: Not Conforming.

General remarks:

• “See form A. ##” refers to additional information related to test conducted.

• “See Table ##” refers to a table appended to this report.
• “See Fig. ##” refers to a figure appended to this report.
• “Appendix. ##” refers to a list of figures.
• “Statement of Conformity” Measurement of Uncertainty (MU) values is reproduced in Test Report
wherever test result is affected. The decision rule applies to the quantitative value of test result, that are closer
to the boundary or limiting values defined as per respective applicable standard or customer’s supplied data.
The final value (after adding or subtracting MU) will be compared with limiting of boundary value to judge
whether the test result is Conforming/Not Conforming/In-conclusive. 1

Units of Measurements:

• V – Voltage.
• A – Ampere.
• Ω – Ohm.
• Hz – Frequency
• m – Meter
• °C – Degree Centigrade
• %RH – Relative Humidity
• hPa – Hectopascal

Abbreviations:

• R – Resistance.
• T – Temperature
• m – Meter
• Hrs. – Hours
• EUT – Equipment under test
• Annex A- Test under scope of NABL Accreditation.
• Annex B – Test under scope of Non- NABL Accreditation

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 2 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
Equipment’s used for Testing:

Sr Calibration
Instrument Name Make Sr. No. Range L.C.
No Due Date
Humidity cum
Tech-Mark (-10 - 130) °C 0.1°C
1. temperature SK1011 28/02/2024
services (Ambient-96) %RH 1%
chamber
Impact test
2. Sensor India SWEN/EQ-07 500 gm ± 25 Ball - -
apparatus
Jointed finger SWEN/EQ/06-
3. Sensor India - - -
12mm diameter 02
Analogue force Sanchi
4. 2050120609735 (O to 5) Kgf 0.05Kgf 25/08/2024
gauge Mechanical
5. Digital caliper Insize 1108-150 0-150mm 0.01 mm 20/08/2024
DC / AC :50
Leakage Current
6. HIOKI 150215883 μA/500 μA/5 0.01μA 22/09/2024
tester
mA/50 mA
Temperature
data logger Intelligent
7. ESD Pune (0 – 100) °C 0.1°C 26/01/2024
with sensor 11/M150600

Thermo HTC (-50-70) °C 0.1°C

8. SWEN/EQ-03 20/08/2024
hygrometer instruments (10-99) %RH 1%
Meco
9. Digital ammeter 1604272 (0 to 10) A a.c. 0.01 A 20/09/2024
instruments
Ball pressure test
10. Sensors India SWEN/EQ - 16 20 N ± 0.1N - -
apparatus
11. Measuring Tape – – (0-300) mm 0.1 mm -
SWEN/EQ-26
12. Stopwatch HTC 0-23hrs 59min 59 secs 0.01s 21/02/2024
DG-564
Sound level HTC
13. N693912 (30-130) dB 0.1dB 11/08/2024
meter Instruments
14. Standard weights ARC SWEN/EQ/31 (0 to 201) Kg – IC
Digital 47411249WS DC volt: (4 to 1000) V a.c
Multimeter 15B+ FLUKE AC volt: (4 to 1000) V a.c. 0.001
15. Current: (0 to 10) A 08/01/2024
SWEN/EQ-46
a.c./d.c.
AC VOLT 0.002 kV
AC VOLT 0.5 to 5kV a.c. a.c.
DC VOLT
DC VOLT 0.5 to 6kV d.c.
0.002 kV d.c.
50V to 1000VDC 50V
Electrical Safety
GW INSTEK GER-180476 AC CURRENT 3 to 33A AC CURRENT
16. Tester (Hipot 26/01/2024
AC 0.01A AC
Tester 9904)
RESISTANCE RESISTANCE
0 to 650mΩ 0.1mΩ
1 to 60 GΩ
1MΩ
TIME 0.1 to 999.9 s
TIME
0.1 s

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 3 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
General Product Information: (Product information below are provided by the customer)
AgVa Pro Ventilator is a turbine driven mechanical ventilator designed for Adult, Pediatric, and neonatal
patients requiring invasive/non-invasive or continuous or intermittent ventilation support. It typically uses
positive pressure to deliver gas at normal breathing rates and tidal volumes through an endotracheal (ET) tube,
NIV Mask or tracheostomy, and consists of a breathing circuit, a control system, display, GUI and alarms having
battery back-up.

Fig A: Front View Fig B: Rear View

Fig C: LHS View Fig D: RHS View

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 4 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
Bill of Material (Marking Critical Components): (Product information below are provided by the customer)

Circuit Diagram of EUT: (Product information below are provided by the customer)

For detailed schematic diagram refer Documents AGVA-020101 V1.5, AGVA020104, AGVA -020103 & AGVA-
020102.

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 5 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Annex - A

1. Humidity Preconditioning
Clause No 5.7
Temperature cum Humidity Chamber
Equipment Used & its Range (-10 °C to 130) °C – Temperature
(Ambient to 96) % - Humidity
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 16th August 2023 to 22th August 2023
Ambient Temperature (°C) during testing 24.8 – 26.4
Ambient Humidity (%RH) during testing 55 -60

Clause No Test Description Verdict

5.7 Table: Humidity Preconditioning Conforming
Conditions for the preconditioning are :
Humidity Range : 93 % ± 3 % Set humidity : (93±3) %RH
Temperature Range : (20 to 30) °C Set temperature : (28 ±2) ̊C
Total Time : 168 Hr.
Supplementary Information: -

Fig1A: Test Condition

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 6 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
2. Accessible Parts

Clause No 5.9, 5.9.2.1 & 5.9.2.2

Accessibility Probes - IP 2X (Jointed Finger Probe)
Equipment Used & its Range
Force: (1 to 50) N
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 9th August 2023
Ambient Temperature (°C) during testing 26.3
Ambient Humidity (%RH) during testing 55

Clause No Test Description Verdict

5.9.2 Table: Accessible Parts
5.9.2.1 Test Finger Conforming
5.9.2.2 Test Hook
Applied
Applied Part IP Code Probe used Comment
Force
At the power input
socket on rear side of
EUT
Jointed test
At the vent on RHS of IP2X -
Finger
EUT
At the gap of bottom
No hazardous live parts
side of EUT
were accessible during the
Opening between
- test.
enclosure of blower
Opening between Test hook 20N
enclosure of SMPS,
battery and battery
Charger
Supplementary Information: -

Fig 2A: Test location 1 Fig 2B: Test location 2

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 7 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 2C: Test location 3 Fig 2D: Test location 4

Fig 2E: Test location 5

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 8 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
3. ME EQUIPMENT Identification, Marking and Documents

Clause No 7, 7.1, 7.1.2 & 7.1.3

Verification Visual Verification
Equipment used & its Range Stopwatch -(0 to 23hrs 59min 59secs)
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 13th October 2023
Ambient Temperature (°C) during testing 26.5
Ambient Humidity (%RH) during testing 58

Clause No Requirement Verdict

7 Table: ME EQUIPMENT identification, marking and documents
7.1 General
Conforming
7.1.2 Legibility of markings
7.1.3 Durability of markings
Remains Label Curled
Location Test agent Comments
legible loose edges
Marking on front
OK OK OK
side of EUT - Distilled
water, All markings were clearly
Marking on rear
- 96% OK OK OK legible at an angle of 30o
side of EUT
Ethanol, from 1m distance &
- 70% adhesive labels were not
Nameplate sticker
Isoprop OK OK OK worked loose, nor became
on rear side of EUT
yl curled at edges.
Serial No. sticker Alcohol
OK OK OK
of EUT
Supplementary information:

Fig 3A: Before Test Fig3B: After Test

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 9 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 3C: Before Test Fig3D: After Test

Fig 3E: Before Test Fig3F: After Test

Fig 3G: Before Test Fig3H: After Test

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 10 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
4. Protective Earthing, Functional Earthing and Potential Equalization of ME
EQUIPMENT

Clause No 8.6 & 8.6.4

Equipment Used & its Range Hipot (3 to 33) A, (0.01 to 650) mΩ
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 9th August 2023
Ambient Temperature (°C) during testing 25.1
Ambient Humidity (%RH) during testing 51

Clause No Test Description Verdict

8.6 Table: Protective earthing, functional earthing and potential
equalization of ME EQUIPMENT Conforming
8.6.4 Impedance and current-carrying capability
Testing Measured
Application
Location Current Resistance Comments
Time (s)
(A) (mΩ)
At the nut on the rear side of
144.0
EUT’s power circuit enclosure
At the nut on supporting Measured Impedance
structure of motor on rear side 132.7 values between
of monitor protective earth
25 10
At the nut of enclosure on the terminal and metal
rear side of EUT below power 140.6 accessible parts are
circuit enclosure less than 200mΩ.
At the handle on LHS of EUT 128.5
At the handle on RHS of EUT 130.0
Supplementary information:
- All the above measured values are average values of multiple readings taken during the test.

Fig.4A: Test Setup Fig 4B: Schematic connections

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 11 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 4C: Test Location 1 Fig4D: Test Result 1

Fig 4E: Test Location 2 Fig4F: Test Result 2

Fig 4G: Test Location 3 Fig4H: Test Result 3

Fig 4I: Test Location 4 Fig4J: Test Result 4

Fig 4K: Test Location 5 Fig4L: Test Result 5

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 12 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
5. Leakage current and patient leakage current

5.1 Leakage Currents

Clause No 8.7, 8.7.3 & 8.7.4.5

HIOKI – Leakage Current Tester – ST 5540
Equipment Used & its Range AC :50 μA/500 μA/5 mA/50 mA
DC: 50 μA/500 μA/5 mA/50 mA
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 13th October 2023
Ambient Temperature (°C) during testing 26.4
Ambient Humidity (%RH) during testing 57

Clause No Test Description Verdict

8.7 Table: Leakage Currents and Patient Auxiliary Currents
8.7.3 Allowable values Conforming
8.7.4.5 Measurement of the EARTH LEAKAGE CURRENT
Comment
Input Voltage :
262.0 V a. c.
Measured Earth leakage current is less
Line – Ground Voltage :
264.0 V a. c.
than 5mA and 10mA in normal condition
Neutral – Ground Voltage :
2.4 V a. c.
and single fault condition respectively.
Frequency :
50 Hz
Normal Condition Single Fault Condition
Location Polarity: Polarity: Polarity: Polarity: Reverse
Normal (mA) Reverse (mA) Normal (mA) (mA)
Earth leakage current 0.359 0.355 0.648 0.646

Supplementary information:
- The measurement is done for 10 s.

Fig.5.1A: Test result

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 13 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
5.2. Leakage Currents

Clause No 8.7, 8.7.3 & 8.7.4.6

HIOKI – Leakage Current Tester – ST 5540
Equipment Used & its Range AC :50 μA/500 μA/5 mA/50 mA
DC: 50 μA/500 μA/5 mA/50 mA
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 13th October 2023
Ambient Temperature (°C) during testing 26.4
Ambient Humidity (%RH) during testing 57

Clause No Test Description Verdict

8.7 Table: Leakage Currents and Patient Auxiliary Currents
8.7.3 Allowable values Conforming
8.7.4.6 Measurement of the TOUCH CURRENT
Comments
Input Voltage : 262.0 V a. c.
Measured touch currents are less than 100µA &
Line – Ground Voltage : 264.0 V a. c.
500µA in normal condition and single fault
Neutral – Ground Voltage : 2.4 V a. c.
condition respectively.
Frequency : 50 Hz
Single Fault Single Fault
Normal Condition
Condition Condition
Location Polarity: Polarity: Polarity: Polarity: Polarity: Polarity:
Normal Reverse Normal Reverse Normal Reverse
(µA) (µA) (µA) (µA) (µA) (µA)
Enclosure to Earth 2.1 2.4 354.6 348.1 2.9 3.2
Enclosure to Enclosure 2.0 2.7 2.7 3.0 2.6 3.0

Supplementary information:
- The measurement is done for 10 s.
- The EUT got failed in enclosure to earth leakage current measurement on 22nd August 2023 & it is
retested on 13th October 2023 after the modification of EUT by the client, test got passed.

Fig 5.2A: Test result 1 Fig 5.2B: Test result 1

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 14 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 5.2C: Test result 2 Fig 5.2D: Test result 2

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 15 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
5.3 Leakage Currents

Clause No 8.7, 8.7.3 & 8.7.4.7

HIOKI – Leakage Current Tester – ST 5540
Equipment Used & its Range AC :50 μA/500 μA/5 mA/50 mA
DC: 50 μA/500 μA/5 mA/50 mA
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 13th October 2023
Ambient Temperature (°C) during testing 26.4
Ambient Humidity (%RH) during testing 57

Clause No Test Description Verdict

8.7 Table: Leakage Currents and Patient Auxiliary Currents
8.7.3 Allowable values Conforming
8.7.4.7 Measurement of the PATIENT LEAKAGE CURRENT
Comments
Input Voltage : 262.0 V a. c. For d.c., Measured patient leakage currents are
Line – Ground Voltage : 264.0 V a. c. less than 10µA & 50µA in normal condition and
Neutral – Ground Voltage : 2.4 V a. c. single fault condition respectively.
Frequency : For a.c., Measured patient leakage currents are
50 Hz less than 100µA & 500µA in normal condition
and single fault condition respectively.
Single Fault Single Fault
Normal Condition
Condition Condition
Location Polarity: Polarity: Polarity: Polarity: Polarity: Polarity:
Normal Reverse Normal Reverse Normal Reverse
(µA) (µA) (µA) (µA) (µA) (µA)
Patient connection to
0.2 0.1 0.1 0.1 0.2 0.1
earth (DC)
Patient connection to
2.6 2.7 329.7 324.7 1.6 1.9
earth (AC)

Supplementary information:
- The measurement is done for 10 s.

Fig 5.3A: Test result Fig 5.3B: Test result

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 16 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 5.3C: Test result

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 17 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
6. Dielectric Strength
Clause No 8.8.3
Equipment Used & its Range Hipot (0.1to 5) kV a.c.
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 22nd August 2023
Ambient Temperature (°C) during testing 26.5
Ambient Humidity (%RH) during testing 58

Clause No Test Description Verdict

8.8.3 Table: Dielectric Strength Conforming

Testing Application Ramp

Voltage Time Time Comments
Location
(V a.c.) (s) (s)
In between shorted line,
No insulation Breakdown were
neutral terminal & 1500 60 10
occurred during the test.
Protective Earth terminal
Supplementary Information: -
- The test voltage is selected from Table 6 of IEC 6060-1:2005+A1:2012+A2:2020 for peak working voltage
under 212<U ≤ 354 V peak for means of operator protection, protection form Mains part, One MOOP is
1500V a.c. rms.

Fig 6A: Test Setup Fig 6B: Schematic connections

Fig 6C: Test Result

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 18 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
7. Insulating Material

Clause No 8.8.4 & 8.8.4.1

Ball Pressure Test Apparatus
Equipment Used & its Range (-10 to 130) °C – Temperature
Force: 20 N ± 2N
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 30th August 2023
Ambient Temperature (°C) during testing 25.6
Ambient Humidity (%RH) during testing 57

Clause No Test Description Verdict

8.8.4 Insulation other than wire insulation
Conforming
8.8.4.1 Mechanical strength and resistance to heat
Maximum allowed diameter of impression : 2 mm

Test temperature Impression Diameter

Part Comment
(°C) (mm)
Power appliance inlet
125 1.45 Diameter of impression
switch sample
did not exceed 2mm
Sample of enclosure 75 1.30
Supplementary information:

Fig 7A: Test setup 1 Fig 7B: Test Condition 1

Fig 7C: Before Test 1 Fig 7D: After Test 1

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 19 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 7E: Test setup 2 Fig 7F: Test Condition 2

Fig 7G: Before Test 2 Fig 7H: After Test 2

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 20 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
8. Equipment Temperature Rise limits

Clause No 11, 11.1, 11.1.1 & 11.1.2

Equipment Used & its Range Temperature Data Logger - (0 to 200) °C
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 24th August 2023
Ambient Temperature (°C) during testing 26.4
Ambient Humidity (%RH) during testing 54

Clause No Test Description Verdict

11 Table: Protection against excessive temperatures and other
HAZARDS
11.1 Excessive temperatures in ME EQUIPMENT Conforming
11.1.1 Maximum temperature during NORMAL USE
11.1.2 Temperature of APPLIED PARTS
Operating conditions:
Frequency : 50Hz Test room ambient temperature (ta) : 26.4 °C
Voltage : 230±10 Va.c. Test duration : 2 h 04min
Channel Maximum measured
Part Comments
Number Temperature (°C)
At the power inlet switch 1 27.4
On the blower inside of EUT 2 33.4
On the SMPS inside of EUT 3 29.7
On the adapter inside of EUT 4 32.8
The maximum
On Battery inside of EUT 5 28.4
temperature for ME
On the display 6 29.3
equipment parts did
On the power buttons front side
7 27.2 not exceed 60 ̊C for
of EUT
moulded material
On the RHS enclosure of EUT 8 26.9
which are externally
On the LHS enclosure of EUT 9 28.4 accessible & 74 ̊C for
At the RHS handle of EUT 10 25.9 metals.
On the back side of EUT at
11 27.3
bottom side
At backside of display 12 29.6
Ambient 13 26.4
Supplementary Information: -
- The maximum allowable temperature is selected from Table 23 of IEC 60601-1:2005+A1:2012+A2:2020
60 C
̊ for external surface to be touched for 10 sec ≤ t ≤ 1min for moulded material & 74 ̊C for metal parts.

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 21 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 8A: Temperature rise graph

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 22 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
9. Impact Test

Clause No 15.3 & 15.3.3

Equipment Used & its Range Impact Test Apparatus- (500 ± 25) gm Ball
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 16th October 2023
Ambient Temperature (°C) during testing 25.8
Ambient Humidity (%RH) during testing 57

Clause No Test Description Verdict

15.3 Table: Mechanical Strength
Conforming
15.3.3 Impact Test
Conditions for the impact test are:
Weight of the sphere : 500 gm. ± 25 gm.
Diameter of Sphere : 50 mm
Height of drop : 1.3 m
Location Surface Type Type of Impact Comment
On the lower cabinet of
No damage occured during
EUT
Vertical Horizontal the test which could cause un
On the middle cabinet of
acceptable risk.
EUT
Supplementary Information: -

Fig 9A: Schematic diagram

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 23 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Fig 9B: Before Impact 1 Fig 9C: After Impact 1

Fig 9D: Before Impact 2 Fig 9E: After Impact 2

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 24 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
10. Voltage Measurement
Clause No 8.4.3
Equipment Used & its Range Digital Storage oscilloscope - (0.002 to 1000) V
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 23rd August 2023
Ambient Temperature (°C) during testing 25.2
Ambient Humidity (%RH) during testing 59

Clause No Test Description Verdict

Table: ME EQUIPMENT intended to be connected to a
8.4.3 Conforming
power source by a plug
Measured voltage Allowable voltage
Location Comments
(V a.c.) (V a. c.)
Between line One second after
terminal and 4.00 disconnection of plug of EUT,
neutral terminal the voltage between pins of
60
Between line the plug or between supply
terminal and PE 13.2 pins and enclosure did not
terminal exceed 60 V a. c.
Supplementary Information: -

Fig 10A: Test result 1 Fig 10B: Test result 2

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 25 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
11. Power Input Test

Clause No 4.11
Equipment Used & its Range Digital Multimeter 15B+ (0-10) A a.c.
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 8th August 2023
Ambient Temperature (°C) during testing 25.5
Ambient Humidity (%RH) during testing 56

Clause No Test Description Verdict

4.11 Power Input Conforming
Equipment Ratings:
Frequency : 50Hz : 230 ± 10 V a.c.
Voltage
Current : 3A & 4A 110± 10 V a.c.
Applied Voltage Measured
Equipment Comments
(V a. c.) Current (A a.c.)
220 0.277

No load 230 0.285

240 0.385

220 1.469

Full load 230 1.224

Measured values of input
240 1.557 currents at range of voltage
100 0.768 did not exceed more than
10% of its marked value.
No load 110 0.711

120 0.668

100 2.645

Full load 110 2.662

120 2.550
Supplementary Information: -

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 26 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
12. Push Test
Clause No 4.11
Standard weights (0-201kg)
Equipment Used & its Range
Stopwatch (0- 23hrs 59mins 59secs)
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 16th October 2023
Ambient Temperature (°C) during testing 25.9
Ambient Humidity (%RH) during testing 56

Clause No Test Description Verdict

15.3 Table: Mechanical Strength
Conforming
15.3.2 Push test
Applied Force Application Time
Location Comment
(N) (s)
No damage occurred during the
On top enclosure
250 5 test which could cause
of EUT.
unacceptable risk.
Supplementary information:
- Force has been applied on EUT through circular plane surface of 30 mm diameter.

Fig 12A: Before Test Fig 12B: After Test

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 27 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
13. Measurement of Creepage and Clearances

Clause No 8.9, 8.9.1.1, 8.9.1.4, 8.9.1.10, 8.9.1.12 & 8.9.4

Equipment Used & its Range Digital Caliper (0-150) mm
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 01st September 2023
Ambient Temperature (°C) during testing 27.8
Ambient Humidity (%RH) during testing 55

Clause No Test Description Verdict

8.9 Table: Creepage distances & air clearances
8.9.1.1 General
8.9.1.4 Minimum CREEPAGE DISTANCE
Conforming
8.9.1.10 AIR Clearances from MAINS PARTS
8.9.1.12 SECONDARY CIRCUITS
8.9.4 CREEPAGE DISTANCES and AIR CLEARANCES
Measured Measured
Applied Part Creepage distance Clearance Comment
(mm) distance (mm)
(For 230V a.c.)
The measured values of
Between line &
creepage distance and air
neutral terminal at 14.45 9.67
clearance are greater than 2.5
the input side of
mm and 2.00 mm respectively.
SMPS
(For 24 V d.c.) The measured values of
Between positive & creepage distance and air
3.31 3.31
negative terminal at clearance are greater than
the input side of PCB. 1.00 mm.
Supplementary Information: -
- The measured values of air clearance distance are selected from Table 13 of IEC60601-1-2005+ A1:2012+
A2:2020 for mains voltage under 150 V ≤nominal mains voltage ≤ 300 V for pollution degree 2, 1moop is
2.00 mm.
- The minimum value of creepage distance is selected from table 16 of IEC60601-1:2005+A1:
2012+A2:2020, for working voltage under 250 V a. c., pollution degree 2 and material group IIIa/IIIb is
2.5 mm.
- The measured values of air clearance distance are selected from Table 15 of IEC 60601-1-2005+A1:2012+
A2:2020 for secondary working voltage under 71Vd.c. under 150V ≤ NMV ≤ 300 for pollution degree 2, 1
MOOP is 1.0mm.
- The minimum value of creepage distance is selected from table 16 of IEC 60601-1:2005+A1:
2012+A2:2020, for working voltage under 25V d.c., pollution degree 2 and material group IIIa/ IIIb is 0.5
mm. Hence, as value of creepage cannot be lesser than clearance, so the value of creepage is equal to
clearance value i.e., 1.0mm

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 28 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
14. Mould Stress Relief Test
Clause No 15.3 & 15.3.6
Temperature cum Humidity Chamber
Equipment Used & its Range
(-10 to 130) °C – Temperature
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 24th August 2023
Ambient Temperature (°C) 25.8
Ambient Humidity (%RH) 58

Clause No Test Description Verdict

15.3 Table: Mechanical Strength

Conforming
15.3.6 Mould Stress Relief Test

Comment
Conditions for the preconditioning are :
No damage occurred during and
Temperature Range : (70 ± 2) °C after the test which could cause
Total Time : 7 Hr unacceptable risk.

Supplementary Information:

Fig.14A: Test Setup Fig 14B: Test Condition

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 29 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
15. Cord anchorage Test

Clause No 8.11 & 8.11.3.5

Equipment Used & its Range Cord anchorage tester (0.35) Nm.
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 31st August 2023
Ambient Temperature (°C) during testing 27.5
Ambient Humidity (%RH) during testing 55

Clause No Test Description Verdict

8.11 Table: MAINS PARTS, components and layout
Conforming
8.11.3.5 Cord Anchorage
Length Length of No. of Torque Length of Length of
Applied Applied
Part of of cord conductor pull-on applicat- conduct- cord sheath
pull force torque
cord sheath before test cord ion time or after after test
(Nm) (Nm)
(mm) (mm) sheath (s) test(mm) (mm)
Main plug 80.06 0 0 81.20
Connector 25 100 0.35 60
80.06 0 0 80.13
end
The length of cord sheath did not displace more than
Comment
2.00mm, nor the conductor moved more than 1.00 mm.

Supplementary Information: -

Fig 15A: Test setup 1 Fig 15B: Test setup 2

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 30 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
 Annex-B

16. Sound Level

Clause No 9.6.2 & 9.6.2.1

Sound Level Meter
Equipment Used & its Range
Lp: 30~130db(A)
Included in Test Report
Uncertainty N/A
Not Included in Test Report
Date of Performance 6th September 2023
Ambient Temperature (°C) during testing 25.9
Ambient Humidity (%RH) during testing 57

Clause No Test Description Verdict

9.6.2 Acoustic energy
Conforming
9.6.2.1 Audible acoustic energy
Measured
Locations tested Comment
values(dBA)
At operator position in normal
54.9
operating condition. The measured maximum sound pressure
At the operator position in alarming level did not exceed 80 dBA.
63.1
condition
Supplementary information:

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 31 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com
Copy of marking plate:

Tested By : Vinod Gaikwad

(Assistant Testing Engineer)

Tested By : Vaibhav Chavan

(Assistant Testing Engineer)

Tested By : Vinay Kumar

(Testing Engineer)

Reviewed & Approved By: Amiya Sagar

(Technical Manager)

END OF TEST REPORT

Test Report No: SWEN/23-24/346-02 Format No: F-04 Page No: 32 of 32

SWEN KONFORMITY, Gokul RH-01, S.no 22, Kranti Nagar road, GK Lane no.7, Near Chattrapati Urban Co-op Bank, Vishal Nagar, Pimple Nilakh,
Pune-411027, Maharashtra (India). Mob.: +91 84129 95928, 99601 95235, Email: [email protected], Website: swenlab.com