TAX INVOICE                                                                  ORIGINAL
                                                                                                                                                                                                           For Recipient
                         ASHIRWAD BANERJEE
                         PURE SAMLA COLLIERY,OFFICE                                                                                    GSTIN 19BENPB0624M1ZE Invoice Date    28/01/2021
                         PARA,P.O:-
                                                                                                                                                           State    19-West Bengal         Invoice No.          GST3617
                         NATUNDANGA,BARDHMAN,
                         NATUNDANGA, West Bengal                                                                                         PAN     BENPB0624M          Reference No.
                         713381
                         9933982855
                         ashirwadbanerjee90@gmail.com

Customer Name                                                             Billing Address                                                            Shipping Address
BAJAJ ALLIANZ GENERAL INSURANCE                  BAJAJ ALLIANZ GENERAL INSURANCE                BAJAJ ALLIANZ GENERAL INSURANCE
COMPANY LIMITED                                                  COMPANY LIMITED                                                COMPANY LIMITED
                                                                                  MANI SQUARE,6TH                                                MANI SQUARE,6TH
                                                                                  FLO0R,164,MANICKTALA MAIN                            FLOOR,164,MANICKTALA MAIN
Customer GSTIN                                                            ROAD,PREMISES # 41,CANAL CIRCLE                   ROAD,PREMISES # 41,CANAL CIRCLE
19AABCB5730G1ZU                                                 ROAD,MANI SQUARE PREMISES, KOLKATA          ROAD,MANI SQUARE PREMISES, KOLKATA
                                                                                  West Bengal, 7000054                                           West Bengal, 7000054
                                                                                  India                                                                       India
                                                                                                                                                                  19AABCB5730G1ZU

Place of Supply 19-West Bengal                                      Due Date 28/01/2021

INSURED NAME SK ABU KALAM                                     VEHICLE NUMBER NL-01-G-9534                                    CLAIM NUMBER 0C-21-2401-1803-00002120
POLICY NUMBER 0G-21-4772-1803-00000153                   PLACE OF SUPPLY DURGAPUR

        Item                                               HSN /       Quantity  Rate / Item      Discount      Taxable Value      CGST ()  SGST / UTGST     CESS           Total ()
                                                              SAC                       (c)                ()             ()                                  (3)                   (2)
  1. FINAL SURVEY FEES                    997162  1.00          1,200.00          0.00         1,200.00     108.00               108.00      0.00         1,416.00
                                                                                                                                                                 @9%                 @9%
 2. CONVEYANCE TO                         997162  3.00            500.00          0.00         1,500.00     135.00              135.00      0.00         1,770.00
        PANDAVESWAR                                                                                                                              @9%                @9%
                                                                                                      Total                           2,700.00  243.00            243.00      0.00        3,186.00

                                                                                                                                                                                     Taxable Amount                 2,700.00
                                                                                                                                                                                              Total Tax                   486.00
                                                                                                                                                                                  Total Value      ? 3,186.00

                                                                                                                                Total amount (in words)      Three Thousand One Hundred Eighty Six Rupees Only

                                                                                                                                                                                                      For ASHIRWAD BANERJEE

                                                                                                                                                                                                             Authorised Signatory
Notes:
PROCESSED BY SOUMEN
PHOTO BY SOUMEN
Terms & Conditions:
VALIDITY-12/04/2022                                                                                                                                             Ashirund Banerqx
LICENSE NO-120204
                                                                                                                                                                      ASHIRWAD BANERJEE
                                                                                                                                                                     INSURANCE SURVEYOR & LOSS ASSESSOR

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