Shailesh Shah
Loss Assessor
                                                                       H.O.:S.V.P.Road,Saiyedwada,Opp.Rajai Cycle Mart,Godhra -389 001.(Gujarat
   Engineer                                                      Ph.: (O)242741,250415 E-mail : sk15.shailesh@gmail.com
                                                                       Br. Off.:11,Nilgiri TereceOpp. Punjabi DhabhaNr, Hari Nagar Crossing,
     Valuer                                                        Gotri Road,Vadodara. (Gujarat) M.:98250 42074,99987 67121,99798 62074




                  GSTIN NO.:24AHKPS0293G1Z8                                 PAN No.:AHKPS0293G
                                           IRDA LICENSE NO.IRDA/IND-SLA-14663(Valid Up To 30-12-2022)
                   INVOICE NO.38227                                                    DATEJuly20,2020
                   BILLED TO,
                   M/s.BAJAJ ALLIANZ GENERALINSURANCE COMPANY LTD.      BUY.GSTIN NO         24AABCB5730G1Z3
                   4O1,ATLANTIS HERITAGE,OPP.SWAGAT PETROL
                   PUMP,SARABHAI MAIN ROAD,NEAR GENDA
                   CIRCLE,VADODARA-390007,GUJARAT                   PAN No.                    AABCB5730G
                   GUJARAT                                                                  PLACE OFSUPPLY:GUJARAT
                   GODHRA                GUJARAT               INDIA         STATE OF SUPPLY:GUJARAT

                   PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
                   OUR REPORT REF.NO.                      38227
                   INSURED                                         MR.DAOODBHAI JETHRA
                   POLICY NO.                                      OG-21-2201-1803-00000356
                   CLAIM NO.                                      OC-21-2201-1803-00000067
                   MV NO.                                          GJ09AV3940

                   DESCRIPTION OF SERVICE CHARGES                                                                 AMOUNT
                   PROFESSIONALSURVEY FEES:                                                                  Rs.             1000.00
                   CONVEYENCE:                              0      KMS.  @   Rs.          7.50         Rs.              350.00
                   HALTING ALLOWANCE :                                                                            Rs.                      0
                   PHOTOGHRPHS:                            1      NOS.  @   RS.         50.00         Rs.                    40
                   OTHERS:                                                                                               Rs.                      0
                   TOTAL TAXABLE AMOUNT:                                                                     Rs.             1390.00
                        HSN/SAC                                                              CGST    @       9%  Rs.               125.10
                          CODE                    TAXES (00440169)                  SGST    @       9% Rs.               125.10
                         997162                                                                IGST     @       0% Rs.                   0.00
                                                                           TOTALINVOICE AMOUNT WITH TAX     Rs.             1640.20
                      Amount In Words:ONE THOUSAND SIX HUNDRED FORTY RUPEES AND TWENTY PAISA ONLY.

                        HSN/SAC         TAXABLE           CENTRAL TAX              STATE TAX             INTERSTATE TAX
                          CODE              VALUE          RATE     AMOUNT      RATE      AMOUNT      RATE      AMOUNT
                         997162            1390.00           9%       125.10        9%        125.10        0%          0.00
                    TOTAL TAX RS.        250.20      TWO HUNDRED FIFTY RUPEES AND TWENTY PAISA ONLY.

                   BANK DETAILS
                                                                                                             Suune
                   BANK NAME:    HDFC BANK LIMITED
                   BRANCH            GODHRA BRANCH                                         B : 3
                   IFSCCODE   :   HDFC0000784
                   MICR CODE  :    389240001
                   A/C.NO.           07841000000792
                   E&O.E-Subject to Godhra Jurisdiction                                                       (SHAILESH SHAH)
                                                                                                       License No.IRDA/IND/SLA-14663 Valid up to 30-12-2022

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