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-201920-1999 Policy no.: 0G-20-2204-1803-00003924 Invoice date: 23/10/2020 Vehicle number: GJ-23-X-8742 Estimate Amount : 295000 Insured Name: RAHULBHAI SAMBAD State: Gujarat Code 24 Claim no. : 0C-21-2204-1803-00000221 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 2500 0 2500 9 225 9 225 2950 2Local Expense 997162 1 300 300 0 300 9 27 9 27 354 3 Outstation 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 5 C.D. Expense : 997162 1 50 50 0 50 9 4.5 9 4.5 59 6Traveling Expense : 260 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 3 2850 0 2850 256.5 256.5 3363 Total Invoice amount in words Total Amount before Tax 2850 Add: CGST 256.5 Add: SGST 256.5 THREE THOUSAND THREE HUNDRED SIXTY THREE RUPEES. Total Tax Amount 513 Total Amount after Tax: 3363 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---