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-201920-1696 Policy no.: 0G-20-9906-1801-00132761 Invoice date: 04/08/2020 Vehicle number: UK-07-BM-8855 Estimate Amount : 275000 Insured Name: PARESH PALA State: Gujarat Code 24 Claim no. : 0C-21-2204-1801-00000703 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 Discount Taxable Value Total No. Rate Amount Rate Amount 1Survey Fee 997162 1 2500 5000 0 5000 9 450 9 450 5900 2Local Expense 997162 1 250 250 0 250 9 22.5 9 22.5 295 3Outstation Allowance 997162 0 0 o 0 o 9 0 9 0 0 4Spot Survey Fee 997162 0 0 0 0 0 9 0 9 0 0 5C.D. Expense : 997162 0 0 0 0 0 9 0 9 o 0 6| Traveling Expense : 997162 0 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 o 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 0 0 0 9 0 9 0 0 Total 2 5250 0 5250 472.5 472.5 6195 Total Invoice amount in words Total Amount before Tax 5250 Add: CGST 472.5 Add: SGST 472.5 SIX THOUSAND ONE HUNDRED NINTY FIVE RUPEES. Total Tax Amount 945 Total Amount after Tax: 6195 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 IMANT KOT ---PAGE END---