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-201920-1678 Policy no.: 0G-20-2204-1803-00003804 Invoice date: 31-07-2020 Vehicle number: GJ-03-BW-9095 Estimate Amount : 300328 Insured Name: AMITBHAI ANSURA State: Gujarat Code 24 Claim no. : 0C-21-2204-1803-00000115 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 1 1500 1500 0 1500 9 135 9 135 1770 2Local Expense 997162 1 750 750 0 750 9 67.5 9 67.5 885 3 Outstation Allowance 997162 0 0 o 0 o 9 0 9 0 0 4Spot Survey Fee 997162 0 0 0 0 0 9 0 9 0 0 5C.D. Expense : 997162 1 50 50 0 50 9 4.5 9 4.5 59 6| Traveling Expense : 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 2300 0 2300 207 207 2714 Total Invoice amount in words Total Amount before Tax 2300 Add: CGST 207 Add: SGST 207 TWO THOUSAND SEVEN HUNDRED FOURTEEN RUPEES. Total Tax Amount 414 Total Amount after Tax: 2714 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---