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-201920-2121 Policy no.: 0G-21-2219-1803-00000273 Invoice date: 27/11/2020 Vehicle number: GJ-12-BX-2594 Estimate Amount : Insured Name: SHIVAM LOGISTIC State: Gujarat Code 24 Claim no. : OC-21-2204-1803-00000287 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 FLO0R , 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 0 0 0 0 0 9 0 9 0 0 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 1 750 750| 0| 750| 9 67.5 9 67.5| 885 5 C.D. Expense : 997162 1 50 50| 0 50 9 4.5 9 4.5 59 6 Traveling Expense : 997162 11120] 1120 0 1120 9 100.8 9 100.8 1321.6 160 KM X 7 Rs. To and 0 0| 0 9 0 9 0 0 From MORBI (SPOT) 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 1920 0 1920 172.8 172.8 2265.6 Total Invoice amount in words Total Amount before Tax 1920 Add: CGST 172.8 Add: SGST 172.8 TWO THOUSAND TWO HUNDRED SIXTY FIVE RUPEES AND SIXTY PAISA ONLY Total Tax Amount 345.6 Total Amount after Tax: 2265.6 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---