TAX INVOICE MINESH VALLABHDAS SHAH LICENCE NO.-SLA/63819 Surveyor-Loss Assessors-Valuer-Investigator EXP.DATE:26/04/2021 FIRE-MOTOR-MARINE (C)-ENGINEERING-MISC. IIISLA MEMBERSHIP NO.: F/W/01143 CONTACT :98240 32094 Email: mvshah2@gmail.com OFFICE:97238 15456-BARODA mvshah2@rediffmail.com OFFICE :9824444179-BHARUCH GSTIN NO. 24AHNPS2949A1ZA PAN No.: AHNPS2949A INVOICENO. 1859/20-21 DATE: 15-Mar-21 BILLED TO, M/s. Bajaj Allianz General Insurance Co. Ltd BUY.GSTIN NO 24AABCB5730G1Z3 4th Floor,Atlantis Hetitage,B/h Atlantis Heights PAN No.: AABCB5730G Opp. Swagat petrol pump, Sarabhai Main Road, PLACE OFSUPPLY: GUJARAT Baroda. GUJARAT INDIA STATE OF SUPPLY: GUJARAT PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING, OURJOB REF.NO. #21030660 INSURED/Vehicle No. MR.HITENDRA VASAVA/GJ 16 CP 4036 POLICY NO./Claim no. : OG-21-2225-1871-00000216/OC-21-2203-1871-00000246 DATE OF SURVEY 05-03-2021 PLACE OF SURVEY AT SHREE SEVA AUTOMOBILES VALIA DESCRIPTION OF SERVICE CHARGES AMOUNT PROFESSIONAL SURVEY FEES: ASSESSED LOSS Rs.9200.00 Rs. 350.00 CONVEYENCE(TO&FRO): 90 KMS. @ Rs. 7.50 Rs. 675.00 HALTING ALLOWANCE: Rs. 0.00 PHOTOGHRPHS/CD@40/- 1 NOS. @ Rs. 40.00 Rs. 40.00 OTHERS(INCEDENTALIF ANY): Rs. 0.00 SUB TOTAL TAXABLE : Rs. 1065.00 HSN/SAC CGST @ 9% Rs. 96.00 CODE TAXES (00440169) SGST @ 9% Rs. 96.00 997162 IGST @ 0% Rs. 0.00 TOTALAMOUNT WITH TAX- Rs. 1257.00 Amount In Words : ONE THOUSAND TWO HUNDRED FIFTY SEVEN ONLY HSN/SAC TAXABLE CENTRAL TAX STATE TAX INTERSTATE TAX CODE VALUE RATE AMOUNT RATE AMOUNT RATE AMOUNT 997162 1065.00 9% 96.00 9% 96.00 0% 0.00 TOTAL TAX Rs. 192.00 ONE HUNDRED NINETY TWO ONLY BANK DETAILS FOR PAYMENT BANK NAME : BANK OF BARODA and BRANCH AKOTA AV.SHA : MINESH V.SHAH IFSCCODE : BARBOAKOTAX (SURVEYOR/LOSS ASSESSOR) LIC.No.SLA 63819/18-21 19-18- MICR CODE 390012021 RELOSS : CURRENT A/C.NO. 06760200000417 Advance receipt: MINESH V.SHAH E& O.E-Subject to Vadodara Jurisdiction (PROPRIETOR) ADDRESS :*101,Kanha Appt.,52,Purshottam Nagar,Urmi Cross Road.,Akota,Vadodara -390020 ---PAGE END---