RAKESH TRIVEDI
                                                                                                                                                   Mobile no-9425180732 &
SURVEYOR/ LOSS ASSESSOR
                                                                                                                                                                       9826564069
S.L.A.-16997 VALID UPTO 28/09/2023
                                                                                                                              MIG(DIx)-1, M P Housing Board Colony
Category- FELLOW- Motor, Engg,Misc & Fire
                                                                                                                           Near New Bus Stand,SHAHADOL (MP)
PAN : ACWPT4121D
                                                                                                                                             SHAHADOL (MP) Pin 484OO1
iGST No.: 23ACWPT4121D1ZM
                                                                                                                                             email.: rakeshsdl@yahoo.co.in
Bank of Baroda A/C No-12930100005566
 IFCS Code Number-BARBOSOHAGP
 MICR Code Number-484012001
                             RT/7411                                                                                                                         Date: 24/12/2020
tINvoicE No. :
                                                                           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                                           MP20NS1810
  INSURED                                                   SHIV NANDAN PANDEY
  POUCY NO.                                                OG-21-4481-1826-00000215
   Claim Number                                   :       OC-21-2301-1826-00000208
  DATE OF SURVEY                                        23/10/2020-
  PLACE OF SURVEY                                      ANUPPUR (MP)
   DESCRIPTION OF SERVICE CHARGES                                                                                                      AMOUNT
   PROTESSIONAL SURVEY FEES         Assessed Amount                    Rs.                    7625                Rs.                           750.00

   CONVEYENCE : By Car                            110         KMS.       @      Rs.              7.50                Rs.                           825.00
   HOCALPETROL RATE                             71.71        /Its
                                 Shahdol to KOTfVA (MP) & Back By Car MP18CA6069
                                                 Amupar                                                                                Rs.                               0.00
   CONVEYANCE: LOCAL AT SDL

   HALTING ALLOWANCE                             Per day @750/-                                                            Rs.                               0.00

   PHOTOGHRPHS :                                     0           Nos        @       Rs.              40.00               Rs.                               0.00

   TOHRS :                                                                                                                                 Rs.                               0.00
                                                        SUB TOTAL TAXABLE                                                             Rs.                         1575.00
          HSN / SAC                                                                             CGST     @             9%         Rs.                           142.00
             CODE          TAXES (00440169) GST No.: 23ACWPT4121D1ZM       SGST     @             9%        Rs.                           142.00
             997162                                                                               IGST     @             0%        Rs.                               0.00
                                                                                                  TOTAL AMOUNT WITH TAX -         Rs.                         1859.00
             Amount In Words :         RS. ONE THOUSAND EIGHT HUNDRED FIFTY NINE ONLY.
            HSN/ SAC           TAXABLE                 CENTRAL TAX                         STATE TAX                            INTERSTATE TAX
              CODE                VALUE               RATE             AMOUNT         RATE           AMOUNT
                                                                                                                                                   RATE                 AMOUNT
              997162              1575.00               9%              142.00           9%            142.00               0%
                                                                                                                                                                             0.00
         TOTAL TAX Rs.          284.00      RS. TWO HUNDRED EIGHTY FOUR ONLY.

                                                                                                                                                    SHTRIK             lise
                                                                                                                                                                        RAKESH TRIVEDI
      & O.1SubjecI to Shahdol (MP) Jurisdiction.                                                                                        SURYEYGR/LOSS ASSESSOR
                                                                                                                                                     or.ce
                                                                                                                                                                   S

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