RAKESH TRIVEDI
 SURVEYOR/ LOSS ASSESSOR                                                                                              Mobile no-9425180732 &
 S.L.A.-16997 VALID UPTO 28/09/2023                                                                                                   9826564069
Category- FELLOW- Motor, Engg.Misc & Fire                                                   MIG(DIx)-1, M P Housing Board Colony
PAN : ACWPT4121D                                                                                          Near New Bus Stand,SHAHADOL (MP)
GSt No.: 23ACWPt4121D1ZM                                                                                          SHAHADOL (MP) Pin 484001
Bank of Baroda A/C No-12930100005566                                                                       email.: rakeshsdl@yahoo.co.in
IFCS Code Number-BARB0SOHAGP
MICR Code Number-484Q12Q01
INVOICE NO. :        RT/6851                                                                                                                      DATE: 30/09/2020
                                                                          TAX CREDIT INVOICE
BILLED TO.
THE CLAIMS MANAGER                                                                         BUY. GSTIN NO    23AABCB5730G1Z5
Bajaj Allianz General Insurance Co Ltd, BHOPAL                                     PAN No. :             AABCB5730G
BHOPAL(MP)                                                                                        PLACE OF SUPPLYBHOPAL (MP)
BHOPAL (MP)                     M P                          INDIA                       STATE OF SUPPLYM P
PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
Vehile Number                                           MP20CK3318
INSURED                                                    MR KAUSHAL GUPTA
POLICY NO.                                                 OG-20-3443-1825-00000288
Claim Number                                            OC-21-2301-1825-00000312
DATE OF SURVEY                                        25/09/2020-
PLACE OF SURVEY                                       M/S GUPTA AUTOMOBILES, SHAHDOL (MP)
 DESCRIPTION OF SERVICE CHARGES                                                                                                     AMOUNT
 PROFESSIONAL SURVEY FEES         Assessed Amount                    Rs.                    20821               Rs.                        1000.00
                                                                                                                                                Rs.
 CONVEYENCE : By Car                              0           KMS.       @      Rs.              7.50                Rs.                              0.00
 LOCAL PETROL RATE                             71.71        /Its
                              Shahdol to UMARIYA (MP)& Back By Car MP18CA0469
 CONVEYANCE: LOCAL AT SDL               LOCAL AT SHAHDOL                                                          Rs.                          250.00
                                                                                                                                                Rs.
 HALTING ALLOWANCE                             Per day @750/-                                                           Rs.                              0.00
 PHOTOGHRPHS :                                     1           Nos        @      Rs.             40.00               Rs.                            40.00
 OTHERS :                                                                                                                                Rs.                              0.00
                                                      SUB TOTAL TAXABLE                                                            Rs.                         1290.00
       HSN / SAC                                                                              CGST     @             9%         Rs.                           116.00
         CODE :         TAXES (00440169) GST No.: 23ACWPT4121D1ZM      SGST     @            9%        Rs.                          116.00
                                                                                                     IGST     @             0%        Rs.                              0.00
         997162
                                                                                                TOTAL AMOUNT WITH TAX -         Rs.                         1522.00
         Amount In Words :         RS. NINE HUNDRED THIRTY TWO ONLY.
        HSN/SAC           TAXABLE                  CENTRAL TAX                         STATE TAX                           INTERSTATE TAX
                                  VALUE               RATE            AMOUNT         RATE          AMOUNT             RATE                AMOUNT
          CODE
                                  1290.00                9%               116.00           9%            116.00               0%                   0.00
          997162
    TOTAL TAX RS.          232.00      RS. ONE HUNDRED FOURTY TWO ONLY.

                                                                                                                                                      RIVEDY     RAKESH TRIVEDI
                                                                                                                                                     SURVEYOR/LOSS ASSESSOR
 L & O.E - Subject to Shahdol (MP) Jurisdiction.

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