TAX INVOICE                                                                  ORIGINAL
                                                                                                                                                                                                             For Recipient
                         ASHIRWAD BANERJEE
                         PURE SAMLA COLLIERY,OFFICE                                                                                     GSTIN 19BENPB0624M1ZE Invoice Date    20/01/2021
                         PARA,P.O:-
                                                                                                                                                            State    19-West Bengal         Invoice No.          GST3599
                         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
                                                                                   FLOOR,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 20/01/2021

INSURED NAME MR MD RIYAJUDDIN KHAN                       VEHICLE NUMBER WB37C1303                                      CLAIM NUMBER 0C-21-2401-1803-00002225
POLICY NUMBER 0G-21-2409-1803-00000312                   PLACE OF SUPPLY DURGAPUR

        Item                                                      HSN /       Quantity  Rate / Item     Discount      Taxable Value    CGST ()   SGST / UTGST   CESS          Total ()
                                                                     SAC                       (Z)                ()             ()                                 ()                  ()
  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. COVEYANCE TO BORAKOR(ONE        997162  1.00            950.00         0.00          950.00       85.50             85.50     0.00         1,121.00
        SIDE 65 KMS)                                                                                                                                      @9%              @9%
                                                                                                            Total                         2,150.00  193.50          193.50     0.00        2,537.00

                                                                                                                                                                                       Taxable Amount                 2,150.00
                                                                                                                                                                                               Total Tax                   387.00
                                                                                                                                                                                   Total Value       2,537.00

                                                                                                                               Total amount (in words)      Two Thousand Five Hundred Thirty Seven Rupees Only

                                                                                                                                                                                                        For ASHIRWAD BANERJEE

                                                                                                                                                                                                              Authorised Signatory
Notes:
PROCESSED BY PROTYUSH
PHOTO PROTYUSH                                                                                                                                                                        Ashirnmd fBaneqxe
Terms & Conditions:
                                                                                                                                                                                              ASHIRWAD BANERJEE
VALIDITY-12/04/2022
                                                                                                                                                                                             INSURANCE SURVEYOR& LOSS ASSESSOR
                                                                                                                                                                                                    LICENCE NO.-120204

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