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         CUTESLA                          K.RAZENDHIRANE B.E., B. SC., FIISLA., F.I.L.A,
              WSLA                                Insurance Surveyour/Loss Assessor
            UTISLA        Member Ship"Fellow-FS/03749  SLA35136Validity02.12.2022
                                        Off:11A,Vallalar Road,Kamaraj Nagar,Pondicherry -605011
        Res: No.2; Mariamman Koil Street, Kurumbapet, Pondicherry -605009. e-mail : razendhirane@gmail.com,
                                       Mobile No9842333589,9629933589,Tel No0413-4207797.
                          PAN No:AETPR1940K                                       GST No:34AETPR1940K1Z0
                                TAX INVOICE for the SERVICE PROVIDED in duplicate
   Reverse Charge                                                             Place of survey                     Villupuram
   Invoice No.                     520                                          Invoice Date:                      22.12.2020
                                                                Details of Receiver I Billed to
   Name                          M/s. Bajaj Allianz General Insurance Co Ltd
   Address                       Chennai

   GSTIN                          33AABCB5730G1Z4
   Policy Number                    OG-21-1516-18/02-0000300                   Claim                       Motor OD Claims
   Claim Number                    OC-21--1501-1802-00000136            Insured Name                  Mr.Venkatesan

            Name of Product/HSN/                  Taxable                                                                       Total
   S.NoService               SAC      Amount   Value          CGST               SGST                IGST        amount
                                                                            Rate   Amount  Rate    AmounRate    Amount
      1   Insurance Claims   997162               1520.00    0%         0.00   0%       0.00]  18%       273.60
            Total amount                                                                                                                           1793.60
     No                Details
      1   Professional Fees                                                                                                                       750.00
      2   Photo Charges                                                                                   CD                                     50.00
      3   Conveyance Charges                                                                  90 Km X Rs.8/-                           720.00
      3   Batta /Halting charge
      4   Postal/Misc Charges
           Total                                                                                                                                     1520.00
   Total Invoice Amount in Words:                              Total Amount Before Tax                                           1520.00
                                                                             ADDCGST                          9                                    0.00
                                                                            ADDSGST                          9                                    0.00
   Bank Details :                                                      ADD:IGST                         18                                 273.60
   Bank Account No:          005601024553                  Tax Amount : GST                                                    1793.60
   Bank Branch IFSC:          ICICO000056
   Name of the Account      K.RAZENDHIRANE              GST Payable on Reverse Charge
   Branch Name                Mission Street, Pondicherry
  Type                           Saving
                                                                                                           K.RAZENDHIRANE,
                                                                                                         K.RAZENDHIRANE,B.E.B.SC
                                                                                                          SURVEYOR/LOSSASSESSOR
    SLA                                                                                                    LICENCE No:SLA 35136
  35136
PONDY
            E

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