Dhimant R. Shah 204, Amrut Com. Center, Sardarnagar Main Road, Rajkot -360 001 Original for Receipient Tel: +91 281 2464015 PAN NO.:AKNPS3659J GSTIN: 24AKNPS3659J1ZJ Tax Invoice Invoice No: SDR-201920-2560 Policy no.: 0G-21-1919-1803-00001115 Invoice date: 27/03/2021 Vehicle number: GJ-111-X-8703 Estimate Amount : 500000 Insured Name: GUJARAT AMBUJA CEMENTS LTD. State: Gujarat Code 24 Claim no. : 0C-21-2204-1803-00000477 Bill to Party Ship to Party Name: Bajaj Allianz General Insurance Company Ltd. Name: Bajaj Allianz General Insurance Company Ltd. Address:402-408, 4th floor, Turquoise, 4th FLOOR , C G ROAD, Address: 402-408, 4th floor, Turquoise, 4th FLOOR , C G ROAD, Panchwati circle, Ahemdabad, 380006 Panchwati circle, Ahemdabad, 380006 GSTIN: 24AABCB5730G1Z3 GSTIN: 24AABCB5730G1Z3 State: Gujarat Code 24 State: Gujarat Code 24 s. Taxable CGST SGST Product Description SAC code Qty Rate Amount Discount Total No. Value Rate Amount Rate Amount 1Survey Fee 997162 1 5000 5000 0 5000 9 450 9 450 5900 2Local Expense 997162 0 0 0 0| 0 9 0 9 0 0 3 Outstation Allowance 997162 0 0 0 0 0 9 0 9 0 0 4Spot Survey Fee 997162 0 0 o o 0 9 0 9 0 0 5C.D. Expense : 997162 1 50 50 0 50 9 4.5 9 4.5 59 6 Traveling Expense : 997162 1 3248 3248 0 3248| 9 292.32 9 292.32 3832.64 464 KM X 7 Rs. To and 0| 0| 0 9 0 9 0| 0 From KODINAR 0 0 0 9 0 9 o 0 0 o 0 9 0 9 0| 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 0 0 0| 0| 0 9 0 9 o| 0 Total 3 8298 0 8298 746.82 746.82 9791.64 Total Invoice amount in words Total Amount before Tax 8298 Add: CGST 746.82 NINE THOUSAND SEVEN HUNDRED NINETY ONE RUPEES AND SIXTY FOUR PAISA JAdd:SGST 746.82 ONLY Total Tax Amount 1493.64 Total Amount after Tax: 9791.64 Bank Details GST on Reverse Charge 0 Bank A/C: ICICI BANK LTD. Ceritified that the particulars given above are true and correct Bank IFSC:ICIC0000153 Dhimant R. Shah A/C NO.: 015305001007 ---PAGE END---