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-201920-2574                                                  Policy no.: 0G-20-2204-1803-00004478
Invoice date: 30/03/2021                                                        Vehicle number: GJ-03-BV-9261
Estimate Amount : 120000                                                      Insured Name: DINESHBHAI A. LADUMOR
State: Gujarat                                               Code       24   Claim no. : 0C-21-2204-1803-00000545
                                    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 ROAD,
Panchwati circle, Ahemdabad, 380006                                          Panchwati circle, Ahemdabad, 380006
GSTIN: 24AABCB5730G1Z3                                                      GSTIN: 24AABCB5730G1Z3
State: Gujarat                                               Code       24   State: Gujarat                                Code          24
s.                                                                                       Taxable         CGST            SGST
            Product Description         SAC code   Qty  Rate   Amount  Discount                                                              Total
No.                                                                                       Value   Rate    Amount Rate  Amount
  1Survey Fee                      997162    1 1000    1000        o      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         0        0           0     9    0         9        0             0
  4Spot Survey Fee               997162    0     0         o        o           0     9    0         9        0              0
  5C.D. Expense :                 997162    1    50       50|       0         50     9   4.5        9     4.5             59
  6Traveling Expense :           997162    0      0         0        0           0     9    0         9        0             0
                                                                           0        0           0     9    0         9        0|             0
                                                                          0        0           0     9    0         9        0             0
                                                                           0        o           0     9    0         9        0|             0
                                                                          0        0           0     9    0         9        0             0
                                                                          0        0           0     9    0         9        0             0
                                                                          0|       0|           0     9    0         9        o|              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 THOUSAND FIVE HUNDRED TIHRTY FOUR RUPESS ONLY
                                                                                                     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

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