TAX INVOICE                                                                 ORIGINAL
                                                                                                                                                                                                          For Recipient
                         ASHIRWAD BANERJEE
                         PURE SAMLA COLLIERY,OFFICE                                                                                    GSTIN 19BENPB0624M1ZE Invoice Date    30/12/2020
                         PARA,P.O:-
                                                                                                                                                          State    19-West Bengal        Invoice No.          GST3555
                         NATUNDANGA,BARDHMAN,
                                                                                                                                                          PAN     BENPB0624M          Reference No.
                         NATUNDANGA, West Bengal
                         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 30/12/2020

INSURED NAME BIKASH MAHATO                                  VEHICLE NUMBER WB-55-A-6263                                   CLAIM NUMBER 0C-21-2401-1803-00002015
POLICY NUMBER 0G-21-1529-1803-00000836                   PLACE OF SUPPLY DURGAPUR

        Item                                                               HSN I       Quantity  Rate / Item    Discount    Taxable         CGST ()  SGST /        CESS         Total ()
                                                                              SAC                       ()              ()           Value ()                      UTGST ()    ()
  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.CONVEYANCE TO RH                                   997162  1.00       1,900.00        0.00     1,900.00     171.00        171.00    0.00         2,242.00
        AUTOMOBILES,PURULIA(ONE SIDE 130                                                                                                @9%          @9%
        KMS)
                                                                                                                   Total                    3,100.00  279.00      279.00   0.00        3,658.00

                                                                                                                                                                                    Taxable Amount                 3,100.00
                                                                                                                                                                                             Total Tax                   558.00
                                                                                                                                                                                 Total Value      2 3,658.00

                                                                                                                                Total amount (in words)      Three Thousand Six Hundred Fifty Eight Rupees Only

                                                                                                                                                                                                     For ASHIRWAD BANERJEE


                                                                                                                                                                                                            Authorised Signatory
Notes:
                                                                                                                                                                                                  Ashisuad /
PROCESSED BY SOUMEN
                                                                                                                                                                                                 ASHIRWAD BANERJEE
PHOTO BY SOUMEN
                                                                                                                                                                                                INSURANCE SURVEYOR& LOSS ASSESSOR
                                                                                                                                                                                                       LiCENCE NO -120204
Terms & Conditions:
VALIDITY-12/04/2022

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