TAX INVOICE                                                                  ORIGINAL
                                                                                                                                                                                                            For Recipient
                         ASHIRWAD BANERJEE
                         PURE SAMLA COLLIERY,OFFICE                                                                                    GSTIN 19BENPB0624M1ZE Invoice Date    03/02/2021
                         PARA,P.O:-
                                                                                                                                                           State    19-West Bengal         Invoice No.          GST3639
                         NATUNDANGA,BARDHMAN,
                         NATUNDANGA, West Bengal                                                                                         PAN     BENPB0624M          Reference No.
                         713381
                         9933982855
                         ashirwadbanerjee90@gmail.com

Customer Name                                                             Billing Address                                                            Shipping Address
BAJAJ ALLIANZ GENERAL INSURANCE                  BAJAJ ALLIANZ GENERAL INSURANCE                BAJAJ ALLIANZ GENERAL INSURANCE
COMPANY LIMITED                                                  COMPANY LIMITED                                                COMPANY LIMITED
                                                                                  MANI SQUARE,6TH                                                MANI SQUARE,6TH
                                                                                  FLOOR,164,MANICKTALA MAIN                            FLOOR,164,MANICKTALA MAIN
Customer GSTIN                                                            ROAD,PREMISES # 41,CANAL CIRCLE                   ROAD,PREMISES # 41,CANAL CIRCLE
19AABCB5730G1ZU                                                 ROAD,MANI SQUARE PREMISES, KOLKATA          ROAD,MANI SQUARE PREMISES, KOLKATA
                                                                                  West Bengal, 7000054                                           West Bengal, 7000054
                                                                                  India                                                                       India
                                                                                                                                                                  19AABCB5730G1ZU

Place of Supply 19-West Bengal                                      Due Date 03/02/2021

INSURED NAME SURESH RAM                                       VEHICLE NUMBER WB-38-AP-8669                                  CLAIM NUMBER 0C-21-2401-1801-00008982
POLICY NUMBER 0G-21-9910-1801-00118524                   PLACE OF SUPPLY DURGAPUR

        Item                                                           HSN /       Quantity  Rate / Item    Discount     Taxable          CGST ()  SGST /           CESS          Total ()
                                                                          SAC                       ()              (3)            Value ()                       UTGST ()       (3)
  1. FINAL SURVEY FEES                                997162  1.00          750.00         0.00        750.00       67.50             67.50     0.00           885.00
                                                                                                                                                                      @9%              @9%
 2. CONVEYANCE TO B.G GARAGE               997162  1.00          900.00         0.00        900.00       81.00            81.00    0.00         1,062.00
        ASANSOL(ONE SIDE 60KM)                                                                                                                @9%             @9%
                                                                                                               Total                      1,650.00  148.50         148.50    0.00        1,947.00

                                                                                                                                                                                      Taxable Amount                 1,650.00
                                                                                                                                                                                              Total Tax                   297.00
                                                                                                                                                                                  Total Value      ? 1,947.00

                                                                                                                             Total amount (in words)       One Thousand Nine Hundred Fourty Seven Rupees Only

                                                                                                                                                                                                       For ASHIRWAD BANERJEE


                                                                                                                                                                                                             Authorised Signatory
Notes:
PHOTO=RITAM
PROCESS=RITAM                                                                                                                                                                  Ashirud /Banerqxe
Terms & Conditions:
                                                                                                                                                                                      ASHIRWAD BANERJEE
Licence No.-120204
                                                                                                                                                                                     INSURANCE SURVEYOR&LOSS ASSESSOR
                                                                                                                                                                                             LICENCE NO -120204

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