Dhimant R. Shah 204, Amrut Com. Center, Sardarnagar Main Road, Rajkot -360 001 Original for Receipient Tel: +91 281 2464015 PAN NO.:AKNPS3659J GSTIN: 24AKNPS3659J1ZJ Tax Invoice Invoice No: SDR-201920-1915 Policy no.: 0G-20-2204-1803-00002174 Invoice date: 30/09/2020 Vehicle number: GJ-03-AT-2753 Estimate Amount : Insured Name: JASKUBHAI LALU State: Gujarat Code 24 Claim no. : 0C-21-2204-1803-00000180 Bill to Party Ship to Party Name: Bajaj Allianz General Insurance Company Ltd. Name: Bajaj Allianz General Insurance Company Ltd. Address:402-408, 4th floor, Turquoise, 4th FLOOR , C G ROAD, Address: 402-408, 4th floor, Turquoise, 4th FLOOR , C G Panchwati circle, Ahemdabad, 380006 ROAD, Panchwati circle, Ahemdabad, 380006 GSTIN: 24AABCB5730G1Z3 GSTIN: 24AABCB5730G1Z3 State: Gujarat Code 24 State: Gujarat Code 24 s. CGST SGST Product Description SAC code Qty Rate Amount Discount Taxable Value Total No. Rate Amount Rate Amount 1Survey Fee 997162 0 0 o 0 0 9 0 9 0 0 2Local Expense 997162 1 250 250 0 250 9 22.5 9 22.5| 295 3 Outstation Allowance 997162 0 0 o 0 0 9 0 9 0 0 4Spot Survey Fee 997162 1 750 750 0 750 9 67.5 9 67.5 885 5C.D. Expense : 997162 1 50 50 0 50 9 4.5 9 4.5 59 6Traveling Expense : 450 997162 0 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 o 0 0 9 0 9 0 0 0 0 0 9 0 9 o 0 0 0 0 9 0 9 0 0 Total 3 1050 0 1050 94.5 94.5 1239 Total Invoice amount in words Total Amount before Tax 1050 Add: CGST 94.5 Add: SGST 94.5 ONE THOUSAND TWO HUNDRED THIRTY NINE RUPEES. Total Tax Amount 189 Total Amount after Tax: 1239 Bank Details GST on Reverse Charge 0 Bank A/C: ICICI BANK LTD. Ceritified that the particulars given above are true and correct Bank IFSC:ICIC0000153 Dhimant R. Shah A/C NO.: 015305001007 IMANT KOT ---PAGE END---