TAX INVOICE S.L.A No. 74243/15-20 Exp.Date-09-FEB-2020 Pan No.AILPG1759P Ph.-Mobile -9549654777 Er.PREM NARAYAN GUPTA Surveyor and loss Assessor G-39 YASH TOWER BAJAI ROAD SIKAR F-1, 180,Ganesh Nagar Niwaru Road Jhotwara, Jaipur-302012 (Rajasthan), Mobile : 9549654777surveyorpngupta@gmail.com Details of Receiver (Billed to) Name Bajaj Allianz Insurance Co. Ltd Invoice NO. PN202013110 Address Jaipur Date of Invoice 03-10-20 State Rajasthan Vehicle No. RJ44SD4332 State Code 08 Insured Name OM PRAKASH Place of Supply Jaipur Rajasthan Date of accident 08-Oct-20 GSTIN/Unique ID 08AABCB5730G1ZX Policy No. OG-21-3660-1802-00000212 Claim No. OC-21-1401-1802-00000735 SNo Particulars Amount 0.00 1 Spot Professional Fee : 0.00 Photos/ CD Expenses : 0.00 o Conveyance Expenses : 0.00 1625.00 2 Final Professional Fee: 750.00 Photos/CD Expenses : 50.00 Conveyance Expenses : 7.5X110 SIKAR TO SALASAR 825.00 VISIT 2 0.00 3 Reinspection Professional Fee: 0.00 Photos/ CD Expenses : 0.00 Conveyance Expenses : 0.00 Taxable value 1625.00 CGST @ 9% 146.25 SGST @ 9% 146.25 Total Invoice Value In figure) 1918 Total Invoice Value (In Words) Rs. One Thousand Nine Hundred Eighteen Only GSTIN/Unique ID-08AILPG1759P1ZM SAC Code 440169 Bank Name : AXIS BANK LTD SLANO A/CNo. 913010019547059 74243 MICR No. 302211002 PREM NARAYAN GUPTA ---PAGE END---