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-BARBOSOHAGP
 MICR Code Number-484Q12001
 INVOICE NO. :       RT/7053                                                                                                                             DATE:30/10/2020
                                                                              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                                             CG10AA7546
 INSURED                                                      MR RAMESH DIKSENA
 POLICY NO.                                                   OG-20-2322-1801-00000236
 Claim Number                                              OC-21-2301-1801-00000775
 DATE OF SURVEY                                           29/10/2020-
 PLACE OF SURVEY                                         BURHAR Distt- Shahdol (MP)
DESCRIPTION OF SERVICE CHARGES                                                                                                           AMOUNT
PROFESSIONAL SURVEY FEES          Assessed Amount                     Rs.                      2000                Rs.                          1000.00
                                                                                                                                                      Rs.
CONVEYENCE : By Car                               60          KMS.       @       Rs.               7.50                Rs.                            450.00
LOCAL PETROL RATE                               71.71         /Its
                             Shahdol to DHANPURI(MP)& Back By Car MP18CA0469
CONVEYANCE: LOCAL AT SDL                                                                                                           Rs.                                0.00
                                                                                                                                                      Rs.
HALTING ALLOWANCE                              Per day @750/-                                                              Rs.                                0.00
PHOTOGHRPHS :                                      0           Nos         @       Rs.              40.00                Rs.                               0.00
OTHERS :                                                                                                                                       Rs.                                0.00
                                                       SUB TOTAL TAXABLE                                                                Rs.                          1450.00
       HSN / SAC                                                                                 CGST     @             9%         Rs.                            131.00
         CODE :         TAXES (00440169) GST No.: 23ACWPT4121D1ZM       SGST     @             9%         Rs.                           131.00
         997162                                                                                    IGST      @             0%         Rs.                               0.00
                                                                                                   TOTAL AMOUNT WITH TAX -          Rs.                         1712.00
         Amount In Words :         RS. ONE THOUSAND SEVEN HUNDRED TWELVE ONLY.
        HSN/SAC            TAXABLE                   CENTRAL TAX                           STATE TAX                             INTERSTATE TAX
          CODE                VALUE                RATE             AMOUNT          RATE           AMOUNT              RATE                 AMOUNT
         997162               1450.00                9%               131.00            9%             131.00               0%                     0.00
    TOTAL tAX RS.           262.00      RS. TWO HUNDRED SIXTY TWO ONLY.

                                                                                                                                                                           KAKESH TRIVEDI
                                                                                                                                                            SSO
                                                                                                                                                          SURVEYOR/LOSS ASSESSOR
E & O.E - Subject to Shahdol (MP) Jurisdiction.

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