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-201920-2248                                                    Policy no.: 0G-21-2204-1803-00002128
Invoice date: 31/12/2020                                                          Vehicle number: GJ-03-W-8883
Estimate Amount : 110000                                                        Insured Name: ASHVINBHAI G.RAIYANI
State: Gujarat                                                 Code        24   Claim no. : 0C-21-2201-1803-00000353
                                     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 1000     1000        0       1000     9    90         9      90        1180
  2Local Expense                   997162    0      0         0        0           0     9     0          9        0           0
  3 Outstation Allowance         997162    0      0         0        0           o     9     0          9        0          0
  4Spot Survey Fee                997162    0     0         0        0           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   560      560        0        560     9   50.4        9    50.4        660.8
        80 KM X 7 Rs.To and                                          0        0           0     9     0          9        o          0
            From GONDAL                                             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             1610        0       1610         144.9            144.9       1899.8
                                Total Invoice amount in words                                 Total Amount before Tax              1610
                                                                                                        Add: CGST                                144.9
                                                                                                        Add: SGST                                144.9
        ONE THOUSAND EIGHT HUNDRED NINTY NINE RUPEES EIGHTY PAISA.
                                                                                                        Total Tax Amount                       289.8
                                                                                                        Total Amount after Tax:              1899.8
                         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


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