TAX INVOICE ORIGINAL For Recipient ASHIRWAD BANERJEE PURE SAMLA COLLIERY,OFFICE GSTIN 19BENPB0624M1ZE Invoice Date 12/03/2021 PARA,P.O:- State 19-West Bengal Invoice No. GST3775 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 12/03/2021 INSURED NAME TAPAN KUMAR SHYAM VEHICLE NUMBER WB40AK7905 CLAIM NUMBER 0C-21-2401-1802-00002078 POLICY NUMBER 0G-21-2432-1802-00000159 PLACE OF SUPPLY DURGAPUR Item HSN / Quantity Rate / Item Discount Taxable CGST SGST / CESS Total () SAC (3) (3) Value () () UTGST (&) () 1. FINAL SURVEY FEES 997162 1.00 500.00 0.00 500.00 45.00 45.00 0.00 590.00 @9% @9% 2. CONVEYANCE TO MS AUTO 997162 1.00 300.00 0.00 300.00 27.00 27.00 0.00 354.00 MALANDIGHI(LOCAL) @9% @9% Total 800.00 72.00 72.00 0.00 944.00 Taxable Amount 800.00 Total Tax 144.00 Total Value 944.00 Total amount (in words) Nine Hundred Fourty Four Rupees Only For ASHIRWAD BANERJEE Ashirmd Baneque ASHIRWAD BANERJEE INSURANCE SURVEYOR&LOSS ASSESSOR Notes: LICENCE NO.-120204 PHOTO-RITAM PROCESS-RITAM Terms & Conditions: Licence No.-120204 ---PAGE END---