Tax Invoice MOHAMMED UVESH .V.MALVAT Invoice No : 648 Surveyor & Loss Assessor (Moter) Dated : 29-Aug-2020 Lic No SLA73478 Valid Upto August 2020 88 Sarani Society 132' Ring Road Insured Name : BALVANT JASHUBHAI B/h APMC MARKET Vasna Tolnaka Ahmedabad Claim No : OC-21-2202-1800-00000607 GSTIN/UIN: 24AMHPM9424B1Z9 Contact : 9898070189 9925007717 Policy No : OG-20-2202-1802-00042304 E-Mail : uveshmalvat@gmail.com Make and Model : BAJAJ PLATINA Motor Vehicle No : GJ01NR7148 Shipped To Party Billed To Party BAJAJ ALLIANZ GIC LTD BAJAJ ALLIANZ GIC LTD 4TH FLOOR, TURQUOISE BUIL ,, NEAR 4TH FLOOR,TURQUOISE BUIL, NEAR PANCHVATI , CROSSROADS, C,G. ROAD PANCHVATI, CROSSROADS,C,G. ROAD AHMEDABAD 380006 AHMEDABAD 380006 State Name Gujarat, Code : 24 State Name : Gujarat, Code : 24 : 24AABCB5730G1Z3 GSTIN/UIN GSTIN/UIN : 24AABCB5730G1Z3 PAN/IT No : PAN/IT No : Place of Supply Gujarat SI Description of Goods HSN/SAC GST Amount No. Rate 1 01.01 Profesnal Fees 997162 18% 500.00 2 01.02 Conyances Charges 997162 18 % 750.00 SURVEY AT DHOLKA 3 C GST 112.50 4 S GST 112.50 Total 1,475.00 Amount Chargeable (in words) E.&O.E Indian Rupees One Thousand Four Hundred Seventy Five Only HSN/SAC Taxable Central Tax State Tax Total Value Rate Amount Rate Amount Tax Amount 997162 1,250.00 9% 112.50 9% 112.50 225.00 Total 1,250.00 112.50 112.50 225.00 Tax Amount (in words) : Indian Rupees Two Hundred Twenty Five Only Company's PAN : AMHPM9424B Declaration Company's Bank Details We declare that this invoice shows the actual price of the Bank Name :06.01 ICICI BANK goods described and that all particulars are true and A/c No. 034401511645 correct. Branch & IFS Code : Vasna Ahmedabad& ICIC0000344 Customer's Seal and Signature for MOHAMMEDUVESH .V.MALVAT UVESH SUBJECT TO AHMEDABAD JURISDICTION. MAHMEDABAD * ---PAGE END---