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-201920-1982 Policy no.: 0G-21-2204-1803-00000825 Invoice date: 20/10/2020 Vehicle number: GJ-10-X-9342 Estimate Amount : 564500 Insured Name: NAVENDU V. KALARIYA State: Gujarat Code 24 Claim no. : 0C-21-2204-1803-00000128 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 DiscountTaxable Value Total No. Rate Amount Rate Amount 1Survey Fee 997162 1 5000 5000 0 5000 9 450 9 450 5900 2Local Expense 997162 1 600 600 0 600 9 54 9 54 708 3 Outstation Allowance 997162 0 0 0 0 0 9 0 9 0 0 4Spot Survey Fee 997162 0 0 0| 0| 0 9 0 9 0 0 5 C.D. Expense : 997162 1 50 50| 0 50| 9| 4.5 9 4.5| 59 6Traveling Expense : 260 997162 0| 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 0 0 0 0 0 9 0 9 0 0 0 o 0 9 0 9 0 0 0 0| 0 9 0 9 0 0 0 0 0 9 0 9 0 0 Total 3 5650 0 5650 508.5 508.5 6667 Total Invoice amount in words Total Amount before Tax 5650 Add: CGST 508.5 Add: SGST 508.5 SIX THOUSAND SIX HUNDRED SIXTY SEVEN RUPEES ONLY Total Tax Amount 1017 Total Amount after Tax: 6667 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 KOT ---PAGE END---