TAX INVOICE
   Bharat N. Patel
               D.E. (Auto) F.I.I.S.A.                                                                               F-10, Nand Complex
SURVEYOR & LOSS ASSESSOR (SLA- No 34368 Exp. Date : 27-11-2022)                                   A'bad Highway, Out side rly. Crossing
GSTIN NO. - 24ABIPP 8 741J1Z9                                                                             State Highway, Palanpur - 385001
PAN NO. - ABIPP 8741J

BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
GSTIN NO 24AABCB5730G1Z3
402-408, 4th floor, Turquoise, 4th FLOOR , C G ROAD,
Panchwati circle, Ahemdabad, Gujarat-380006
Place of Supplyer : Gujarat              CODE :   24
Inovice N   BA/D/ 2489                                                                                        Inovice Date :                 4/Feb/21

                                                      SAC                  Conve  Travelingg CD     Taxable
Sr. No            Item Description            code   Fees.        Charge   Charge Rs.25   Value         CGST    SGST    IGST
             INSURANCE CLAIMS
             ADJUSTMENT SERVICES                                                 7.00                                       9%       9%       0%
             Details of the surveey
                                                                                             140 Kms.
     1      PROFESSIONAL FEE         997162  1500.00    0.00      980.00     0.00      2480.00       223.20 223.20      0.00
     2     REINSPECTION FEE         997162  0.00         0.00      0.00        0.00      0.00             0.00      0.00      0.00
            Total                                           1500.00    0.00                     0.00      2480.00     223.20   223.20   [0.00
             TOTAL INVOICE VALUE IN FIGURES                                                     2,926.40

             TOTAL INVOICE VALUE IN WORDS               Two Thousand Nine Hundred Twenty Six & Forty
                                                                               Paise only



                                                                                                                        Surveyor Name and Sign


                          POLICY NO.                        :       OG-21-2202-1803-00003834
                          INSURED NAME                 :       M/S. IMPEX INDIA
                          VEHICLE NO.                     :       GJ 20V 9099

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