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-201920-2225 Policy no.: 0G-21-2225-1803-00000305 Invoice date: 29/12/2020 Vehicle number: GJ-19-U-1341 Estimate Amount : 100000 Insured Name: TEJABHAI RUPABHAI BHARWAD State: Gujarat Code 24 Claim no. : 0C-21-2201-1803-00000210 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 DiscountTaxable Value Total No. Rate Amount Rate Amount 1Survey Fee 997162 1 1000 1000 0 1000 9 90 9 90 1180 2Local Expense 997162 1 500 500 0 500 9 45 9 45 590 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 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 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 Total 3 1550 0 1550 139.5 139.5 1829 Total Invoice amount in words Total Amount before Tax 1550 Add: CGST 139.5 Add: SGST 139.5 ONE THOUSAND EIGHT HUNDRED TWENTY NINE RUPEES ONLY Total Tax Amount 279 Total Amount after Tax: 1829 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 KOT ---PAGE END---