RAKESH TRIVEDI
SURVEYOR/ LOSS ASSESSOR                                                                                            Mobile no-9425180732 &
 S.L.A.-16997 VALID UPTO 28/09/2023                                                                                                 9826564069
 Category- FELLOW- Motor, Engg,Misc & Fire                                                  MIG(DIx)-1, M P Housing Board Colony)
                                                                                                                        Near New Bus Stand,SHAHADOL (MP)
  PAN : ACWPT4121D
                                                                                                                                         SHAHADOL (MP) Pin 484001]
  GST No.: 23ACWPT4121D1ZM
                                                                                                                                        email.: rakeshsdl@yahoo.co.in
   Bank of Baroda A/C No-12930100005566
   IFCS Code Number-BARBOSOHAGP
   MICR Code Number-484Q12001

   INVOICE NO. :      RT/7360                                                                                                                  Date: 18/12/2020
                                                                         TAX CREDIT INVOICE
   BILLED TO.
   THE CLAIMS MANAGER                                                                     BUY. GSTIN NO    23AABCB5730G1Z5
   Bajaj Allianz General Insurance Co Ltd, BHOPAL                                  PAN No. :            AABCB5730G
   BHOPAL (MP)                                                                                   PLACE OF SUPPLY BHOPAL (MP) ..
   BHOPAL(MP)                   MP                        INDIA                      STATE OF SUPPLY M P
   PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
   Vehile Number                                :      MP18T2190
  INSURED                                        :      MR BRAJRAJ SINGH
   POLICY NO.                                      :
   Ciaim Number                                  :      OC-21-2301-1801-00000948
   DATE OF SURVEY                              :      30/11/2020-
   PLACE OF SURVEY                             :      M/s. G B MOTOCROP SHAHDOL (MP)
  DESCRIPTION OF SERVICE CHARGES                                                                                                  AMOUNT
   PROFESSIONAL SURVEY FEES        Assessed Amount                   Rs.                   35000              Rs.                        1250.00
   CONVEYENCE : By Car                            0          KMS.      @      Rs.              7.50               Rs.                             0.00
  LOCAL PETROL RATE                            71.71        /Its
                               Shahdol to KOTMA (MP) & Back By Car MP18CA6069
   CONVEYANCE: LOCAL AT SDL              LOCAL AT SHAHDOL              FOR FINAL SURVEY                 Rs.                          250.00

  HALTING ALLOWANCE                            Per day @750/-                                                         Rs.                             0.00
  PHOTOGHRPHS :                                   0          Nos        @      Rs.             40.00              Rs.                             0.00
  OTHERS :                                                                                                                           Rs.                              0.00
                                                    SUB TOTAL TAXABLE                                                          Rs.                        1500.00
        HSN / SAC                                                                          CGST    @            9%        Rs.                          135.00
          CODE :        TAXES (00440169) GST No.: 23ACWPT4121D1ZM      SGST    @            9%        Rs.                          135.00
          997162                                                                            IGST     @            0%        Rs.                             0.00
                                                                                            TOTAL AMOUNT WITH TAX -        Rs.                        1770.00
          Amount In Words :        RS. ONE THOUSAND SEVEN HUNDRED SEVENTY ONLY.
         HSN/SAC          TAXABLE                 CENTRAL TAX                        STATE TAX                           INTERSTATE TAX
           CODE              VALUE              RATE            AMOUNT         RATE          AMOUNT             RATE                AMOUNT
          997162             1500.00               9%              135.00          9%            135.00              0%                   0.00
     TOTAL TAX Rs.          270.00      RS. TWO HUNDREDSEVENTY SEVENTY ONLY.
                                                                                                                                                                               0
                                                                                                                                                                  ee
                                                                                                                                            TRIVE
                                                                                                                                                              RAKESH TRIVEDI
                                                                                                                                               SURVEYOR/LOSS ASSESSOR
 E & O.E - Subject to Shahdol (MP) Jurisdiction.                                                                                               1
                                                                                                                                     I icence No.
                                                                                                                                            16331
                                                                                                                                     P2

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