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-201920-1521 Policy no.: HBZ11716409 Invoice date: 23/06/2020 Vehicle number: GJ-36-B-5857 Estimate Amount : 120066 Insured Name: RAMESHBHAI D ZALARIYA State: Gujarat Code 24 Claim no. : 0C-21-2204-1801-00000075 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 Panchwati circle, Ahemdabad, 380006 ROAD, Panchwati circle, Ahemdabad, 380006 GSTIN: 24AABCB5730G1Z3 GSTIN: 24AABCB5730G1Z3 State: Gujarat Code 24 State: Gujarat Code 24 s. CGST SGST Product Description SAC code Qty Rate Amount Discount Taxable Value Total No. Rate Amount Rate Amount 1Survey Fee 997162 1 750 750 0 750 9 67.5 9 67.5[ 885 2Local Expense 997162 1 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 0 0 0 9 0 9 0 0 5C.D. Expense : 997162 0 0 0 0 0 9 0 9 0 0 6 Traveling Expense : 997162 1 1950 1950 0 1950 9 175.5 9 175.5 2301 260KMS X 7.5RS TO AND 0 0 0 9 0 9 o 0 FROM MORBI. (2 VISIT) 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 o 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 0 0 0 9 0 9 0 0 Total 3 2700 0 2700 243 243 3186 Total Invoice amount in words Total Amount before Tax 2700 Add: CGST 243 Add: SGST 243 THREE THOUSAND ONE HUNDRED EIGHTY SIX RUPEES. Total Tax Amount 486 Total Amount after Tax: 3186 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 IMANT KOT ---PAGE END---