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-201920-2528                                                  Policy no.: 0G-21-2204-1803-00002997
Invoice date: 22/03/2021                                                        Vehicle number: GJ-03-BT-9312
Estimate Amount : 550000                                                       Insured Name: RAVIRAJBHAI K. MANJARIYA
State: Gujarat                                               Code       24   Claim no. : 0C-21-2204-1803-00000437
                                    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
  4 Spot 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 1190     1190]        0      1190     9  107.1       9  107.1          1404.2
       170 KM X 7 Rs. To and                                        0|       0|           o     9     0         9        0|              0
           From GONDAL                                            0        0           0     9    0         9        0             0
                (2 VISIT)                                                 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             6240       0      6240         561.6           561.6|          7363.2
                               Total Invoice amount in words                                Total Amount before Tax                6240
                                                                                                      Add: CGST                                  561.6
 SEVEN THOUSAND THREE HUNDRED SIXTY THREE RUPEES AND TWENTY PAISA  Add: SGST                                   561.6
                                               ONLY                                               Total Tax Amount                        1123.2
                                                                                                      Total Amount after Tax:                 7363.2
                         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---