RAKESH TRIVEDI
SURVEYOR/ LOSS ASSESSOR                                                                                            Mobile no-9425180732 &
S.L.A.-16997 VALID UPTO 28/09/2023                                                                                                 9826564069
Category- FELLOW- Motor, Engg.Misc & Fire                                                  MIG(DIx)-1, M P Housing Board Colony
PAN : ACWPT4121D                                                                                        Near New Bus Stand,SHAHADOL (MP)
GST No.: 23ACWPT4121D1ZM                                                                                        SHAHADOL (MP) Pin 484001
Bank of Baroda A/C No-12930100005566                                                                     email.: rakeshsdl@yahoo.co.in
IFCS Code Number-BARBOSOHAGP
MTCR Code Number-484012001

INVOICE NO. :       RT/7340
                                                                                                                                                            Date: 14/12/2020
                                                                         TAX CREDIT INVOICE
BILLED TO,
THE CLAIMS MANAGER                                                                       BUY. GSTIN NO    23AABCB5730G1Z5
 Bajaj Allianz General Insurance Co Ltd, BHOPAL                                    PAN No. :            AABCB5730G
 BHOPAL(MP)                                                                                     PLACE OF SUPPLYBHOPAL (MP)
 BHOPAL (MP)                    M P                         INDIA                       STATE OF SUPPLYM P
 PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
 Vehile Number                                          MP65S7481
 INSURED                                                   SHRI ABDUL SARIF
 POLICY NO.                                               OG-21-4481-1871-00012502
 Claim Number                                   :      OC-21-2301-1871-00000029
 DATE OF SURVEY                                        09/12/2020-
 PLACE OF SURVEY                              :      M/s Jai Ambe Automobiles, Kotma Distt- Anuppur (MP)
  DESCRIPTION OF SERVICE CHARGES                                                                                                   AMOUNT
  PROFESSIONAL SURVEY FEES         Assessed Amount                    Rs.                    5900               Rs.                         750.00
 CONVEYENCE: By Car                           180 ...     KMS.       @      Rs.              7.50               Rs.                        1350.00
 LOCAL PETROL RATE                             71.71        /Its
                               Shahdol to KOTMA (MP) & Back By Car MP18CA6069
 CONVEYANCE: LOCAL AT SDL                                                                                                   Rs.                             0.00
 HALTING ALLOWANCE                             Per day @750%-                                                          Rs.                             0.00
  PHOTOGHRPHS :                                     0           Nos        @      Rs.             40.00              Rs.                             0.00
  OTHERS :                                                                                                                              Rs.                             0.00
                                                      SUB TOTAL TAXABLE                                                           Rs.                       2100.00
        HSN/SAC                                                                            CGST    @            9%        Rs.                         189.00
           CODE :        TAXES (00440169) GST No.: 23ACWPT4121D1ZM      SGST    @            9%        Rs.                          189.00
                                                                                                    IGST     @            0%        Rs.                             0.00
           997162
                                                                                                TOTAL AMOUNT WITH TAX -         Rs.                       2478.00
           Amount In Words :         RS.TWO THOUSAND FOUR HUNDRED SEVENTY EIGHT ONLY.
          HSN/SAC                                         CENTRAL TAX                         STATE TAX                          INTERSTATE TAX
                                  TAXABLE
                                                             RATE            AMOUNT         RATE          AMOUNT             RATE               AMOUNT
            CODE               VALUE
                                                              9%              189.00           9%            189.00              0%                  0.00
           997162             2100.00
      TOTAL TAX RS.          378.00      RS. THREE HUNDRED SEVENTY EIGHT ONLY.                                                                  7

                                                                                                                                                                  RAKESH TRIVEDI
                                                                                                                                                 TRIVED
                                                                                                                                                     SURVEYOR/LOSS ASSESSOR
                                                                                                                                                        No.1
   : & O.E - Subject to Shahdol (MP) Jurisdiction.
                                                                                                                                                   16007

---PAGE END---