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-201920-1909 Policy no.: 0G-20-2204-1803-00003008 Invoice date: 29/09/2020 Vehicle number: GJ-03-AX-5227 Estimate Amount : 135000 Insured Name: DILIPKUMAR J BAMBHVA State: Gujarat Code 24 Claim no. : 0C-21-2204-1803-00000110 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 1000 1000 0 1000 9 90 9 90 1180 2Local Expense 997162 1 250 250 0 250 9 22.5 9 22.5 295 3 Outstation Allowance 997162 0 0 o 0 o 9 0 9 0 0 4Spot Survey Fee 997162 0 0 0 0 0 9 0 9 0 0 5C.D. Expense : 997162 1 50 50 0 50 9 4.5 9 4.5 59 6Traveling Expense :260 997162 0 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 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 1300 0 1300 117 117 1534 Total Invoice amount in words Total Amount before Tax 1300 Add: CGST 117 Add: SGST 117 ONE HUNDRED FIVE HUNDRED THIRTY FOUR RUPEES. Total Tax Amount 234 Total Amount after Tax: 1534 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---