Printed on 11-Dec-2020 at 11:06 Tax Invoice MOHAMMED UVESH .V. MALVAT Invoice No : 1393 Surveyor & Loss Assessor (Moter) Lic No SLA73478 Valid Upto August 2023 Dated : 11-Dec-2020 88 Sarani Society. 132' Ring Road B/h APMC MARKET Vasna ToInaka Insured Name : BHAVIN PATEL Ahmedabad Gujarat - 380055, India Claim No : OC-21-2202-1801-00006519 GSTIN/UIN: 24AMHPM9424B1Z9 Contact : 9898070189 9925007717 Policy No : OG-21-2202-1801-00012875 E-Mail : uveshmalvat@gmail.com Make and Model : HYUNDAI I-10 Motor Vehicle No : GJ01KN6694 Shipped To Party Billed To Party BAJAJ ALLIANZ GIC LTD BAJAJ ALLIANZ GIC LTD 4TH FLOOR, TURQUOISE BUIL ,, NEAR 4TH FLOOR,TURQUOISE BUIL ,, NEAR PANCHVAtI , CROSSROAdS, C,G. ROAD PANCHVATI , CROSSROADS, C,G. ROAD AHMEDABAD 380006,Gujarat - 380006, India AHMEDABAD 380006,Gujarat - 380006, India State Name : Gujarat, Code : 24 State Name : Gujarat, Code : 24 GSTIN/UIN : 24AABCB5730G1Z3 GSTIN/UIN : 24AABCB5730G1Z3 PAN/IT No PAN/IT No Place of Supply: Gujarat sI Description of Goods HSN/SAC GST Amount No. Rate 1 01.01 Profesnal Fees 997162 18 % 500.00 2 01.02 Conyances Charges 997162 18 % 500.00 SURVEY AT DHOLKA 3 C GST 90.00 4 S GST 90.00 Total ? 1,180.00 Amount Chargeable (in words) E. & O.E Indian Rupees One Thousand One Hundred Eighty Only HSN/SAC Taxable Central Tax State Tax Total Value Rate Amount Rate Amount Tax Amount 997162 1,000.00 9% 90.00 9% 90.00 180.00 Total 1,000.00 90.00 90.00 180.00 Tax Amount (in words) : Indian Rupees One Hundred Eighty Only Company's PAN : AMHPM9424B Declaration Company's Bank Details We declare that this invoice shows the actual price of the Bank Name : 06.01 ICICIBANK goods described and that all particulars are true and A/c No. : 034401511645 correct. Branch & IFS Code : Vasna Ahmedabad & ICIC0000344 Customer's Seal and Signature for MOHAMMED UVESH :V.MALVAT prised Signatory Y SLA738 SUBJECT TO AHMEDABAD JURISDICTION AHMEDABAD]P ---PAGE END---