Tax Invoice MOHAMMED UVESH .V.MALVAT Invoice No 751 Surveyor & Loss Assessor (Moter) Dated Lic No SLA73478 Valid Upto August 2023 : 17-Sep-2020 88 Sarani Society 132' Ring Road Insured Name : BHAVINKUMAR B/h APMC MARKET Vasna Tolnaka Ahmedabad Claim No : OC-21-2204-1802-00000479 GSTIN/UIN: 24AMHPM9424B1Z9 Contact : 9898070189 9925007717 Policy No : OG-20-2202-1802-00036647 E-Mail : uveshmalvat@gmail.com Make and Model : SHINE Motor Vehicle No : GJ04CH5350 Shipped To Party Billed To Party BAJAJ ALLIANZ GIC LTD BAJAJ ALLIANZ GIC LTD 4TH FLOOR,TURQUOISE BUIL,,NEAR 4TH FLOOR,TURQUOISE BUIL,, NEAR PANCHVATI ,CROSSROADS, C,G. ROAD PANCHVATI , CROSSROADS, C,G. ROAD AHMEDABAD 380006 AHMEDABAD 380006 State Name : Gujarat, Code : 24 State Name : Gujarat, Code : 24 GSTIN/UIN 24AABCB5730G1Z3 GSTIN/UIN : 24AABCB5730G1Z3 PAN/IT No PAN/IT No Place of Supply Gujarat SI Description of Goods HSN/SAC GST Amount No. Rate 1 01.01 Profesnal Fees 997162 18 % 500.00 2 01.02 Conyances Charges 997162 18 % 1,500.00 3 S GST 180.00 4 C GST 180.00 Total 2,360.00 Amount Chargeable (in words) E.&O.E Indian Rupees Two Thousand Three Hundred Sixty Only HSN/SAC Taxable Central Tax State Tax Total Value Rate Amount Rate Amount Tax Amount 997162 2,000.00 9% 180.00 9% 180.00 360.00 Total 2,000.00 180.00 180.00 360.00 Tax Amount (in words) : Indian Rupees Three Hundred Sixty Only Company's PAN : AMHPM9424B Declaration Company's Bank Details We declare that this invoice shows the actual price of the Bank Name : 06.01 ICICI BANK goods described'and that all particulars are true and A/c No. 034401511645 correct. Branch & IFS Code : Vasna Ahmedabad & ICIC0000344 Customer's Seal and Signature for MOHAMMEDVVESH .V.MALVAT JVESA SLA 7347 Authorised Signatory AHMEDARAD SUBJECT TO AHMEDABAD JURISDICTION ---PAGE END---