TAX INVOICE                                                                  ORIGINAL
                                                                                                                                                                                                            For Recipient
                         ASHIRWAD BANERJEE
                         PURE SAMLA COLLIERY,OFFICE                                                                                    GSTIN 19BENPB0624M1ZE Invoice Date    26/03/2021
                         PARA,P.O:-
                                                                                                                                                           State    19-West Bengal         Invoice No.          GST3837
                         NATUNDANGA,BARDHMAN,
                         NATUNDANGA, West Bengal                                                                                         PAN     BENPB0624M          Reference No.
                         713381
                         9933982855
                         ashirwadbanerjee90@gmail.com

Customer Name                                                             Billing Address                                                            Shipping Address
BAJAJ ALLIANZ GENERAL INSURANCE                  BAJAJ ALLIANZ GENERAL INSURANCE                BAJAJ ALLIANZ GENERAL INSURANCE
COMPANY LIMITED                                                  COMPANY LIMITED                                                COMPANY LIMITED
                                                                                  MANI SQUARE,6TH                                                MANI SQUARE,6TH
                                                                                  FLOOR,164,MANICKTALA MAIN                            FLOOR,164,MANICKTALA MAIN
Customer GSTIN                                                            ROAD,PREMISES # 41,CANAL CIRCLE                   ROAD,PREMISES # 41,CANAL CIRCLE
19AABCB5730G1ZU                                                 ROAD,MANI SQUARE PREMISES, KOLKATA          ROAD,MANI SQUARE PREMISES, KOLKATA
                                                                                  West Bengal, 7000054                                           West Bengal, 7000054
                                                                                  India                                                                       India
                                                                                                                                                                  19AABCB5730G1ZU

Place of Supply 19-West Bengal                                      Due Date 26/03/2021

INSURED NAME MR HAYDAR ALI SEKH                            VEHICLE NUMBER WB-41-H-1109                                    CLAIM NUMBER 0C-21-2401-1803-00002999
POLICY NUMBER 0G-21-2495-1803-00008957                    PLACE OF SUPPLY DURGAPUR

        Item                                                     HSN /       Quantity  Rate / Item     Discount     Taxable Value    CGST ()   SGST / UTGST   CESS          Total ()
                                                                    SAC                       (3)                (3)             (c)                                 (c)                  (3)
  1. FINAL SURVEY FEES                          997162  1.00         1,200.00          0.00        1,200.00     108.00             108.00     0.00         1,416.00
                                                                                                                                                                    @9%               @9%
 2. CONVEYANCE TO PARAJ(ONE          997162  1.00            650.00         0.00           650.00       58.50              58.50     0.00            767.00
        SIDE 45 KMS)                                                                                                                                     @9%               @9%
                                                                                                           Total                         1,850.00  166.50          166.50     0.00        2,183.00

                                                                                                                                                                                      Taxable Amount                 1,850.00
                                                                                                                                                                                               Total Tax                   333.00
                                                                                                                                                                                  Total Value       2,183.00

                                                                                                                               Total amount (in words)      Two Thousand One Hundred Eighty Three Rupees Only

                                                                                                                                                                                                       For ASHIRWAD BANERJEE


                                                                                                                                                                                                              Authorised Signatory
Notes:
PROCESSED BY SOUMEN
                                                                                                                                                                                             Ashirwd Banerqu
PHOTO BY ASHIRWAD
                                                                                                                                                                                           ASHIRWAD B/ANERJEE
Terms & Conditions:
                                                                                                                                                                                          INSURANCE SURVEYOR& LOSS ASSESSOR
VALIDITY-12/04/2022                                                                                                                                                                       LICENCE NO -120204

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