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-201920-2040 Policy no.: 0G-21-1904-1802-00028391 Invoice date: 31/10/2020 Vehicle number: GJ-32-H-8889 Estimate Amount : 22030 Insured Name: SUMRA BASHIRBHAI AHMADBHAI State: Gujarat Code 24 Claim no. : 0C-21-2204-1802-00000647 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 Panchwati circle, Ahemdabad, 380006 ROAD, Panchwati circle, Ahemdabad, 380006 GSTIN: 24AABCB5730G1Z3 GSTIN: 24AABCB5730G1Z3 State: Gujarat Code 24 State: Gujarat Code 24 s. CGST SGST Product Description SAC code Qty Rate Amount Discount Taxable Value Total No. Rate Amount Rate Amount 1Survey Fee 997162 1 450 450 0 450 9 40.5 9 40.5[ 531 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 4Spot Survey Fee 997162 0 0 0 0 0 9 0 9 0 0 5 C.D. Expense : 997162 1 50 50 0 50 9 4.5 9 4.5 59 6 Traveling Expense : 200 997162 1 1400 1400 0 1400 9 126 9 126 1652 KM X 7 Rs. To and From 0 0 0 9 0 9 o 0 JUNAGADH-VERAVAL 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 o 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 0 0 0 9 0 9 0 0 Total 3 1900 0 1900 171 171 2242 Total Invoice amount in words Total Amount before Tax 1900 Add: CGST 171 Add: SGST 171 TWO THOUSAND TWO HUNDRED FORTY TWO RUPEES. Total Tax Amount 342 Total Amount after Tax: 2242 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 IMANT KOT ---PAGE END---