TAX INVOICE ORIGINAL For Recipient ASHIRWAD BANERJEE PURE SAMLA COLLIERY,OFFICE GSTIN 19BENPB0624M1ZE Invoice Date 30/03/2021 PARA,P.O:- State 19-West Bengal Invoice No. GST3849 NATUNDANGA,BARDHMAN, PAN BENPB0624M Reference No. NATUNDANGA, West Bengal 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 30/03/2021 INSURED NAME MR KRISHNA PRASAD PAL VEHICLE NUMBER WB-33-D-3371 CLAIM NUMBER 0C-21-2401-1803-00003104 POLICY NUMBER 0G-21-2410-1803-00001743 PLACE OF SUPPLY DURGAPUR Item HSN / Quantity Rate / Item Discount Taxable Value CGST () SGST / UTGST CESS Total () SAC (3) (z) () (3) (Z) 1. FINAL SURVEY FEES 997162 1.00 2,500.00 0.00 2,500.00 225.00 225.00 0.00 2,950.00 @9% @9% 2. CONVEYANCE TO 997162 1.00 300.00 0.00 300.00 27.00 27.00 0.00 354.00 @9% @9% PANAGARH Total 2,800.00 252.00 252.00 0.00 3,304.00 Taxable Amount 2,800.00 Total Tax 504.00 Total Value ? 3,304.00 Total amount (in words) Three Thousand Three Hundred Four Rupees Only For ASHIRWAD BANERJEE Authorised Signatory Notes: PROCESSED BY SOUMEN PHOTO BY SOUMEN Ashiruad/Banerqx Terms & Conditions: VALIDITY-12/04/2022 ASHIRWAD BANERJEE LICENSE NO-120204 INSURANCE SURVEYOR& LOSS ASSESSOR ---PAGE END---