Printed on 30-Mar-2021 at 18:41 Tax Invoice MOHAMMED UVESH .V.MALVAT Invoice No 2206 Surveyor & Loss Assessor (Moter) Lic No SLA73478 Valid Upto August 2023 Dated :30-Mar-2021 88 Sarani Society_132' Ring Road B/h APMC MARKET Vasna Tolnaka Insured Name :JAYESHKUMAR PRAJAPATI Ahmedabad Gujarat -380055,India Claim No : OC-21-2202-1803-00000608 GSTIN/UIN:24AMHPM9424B1Z9 Contact :9898070189 9925007717 Policy No OG-20-2216-1803-000000740 E-Mail : uveshmalvat@gmail.com Make and Model : BHARAT BENZ 3123 Motor Vehicle No : GJ24V9115 Shipped To Party Billed To Party BAJAJ ALLIANZ GIC LTD BAJAJ ALLIANZ GIC LTD 4TH FLOOR,TURQUOISE BUIL,,NEAR 4TH FLOOR,TURQUOISE BUILNEAR PANCHVATI,CROSSROADS,C,G.ROAD PANCHVATI,CROSSROADS,C,G.ROAD AHMEDABAD 380006,Gujarat -380006, India AHMEDABAD 380006,Gujarat-380006,India 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% 5,000.00 2 01.02 Conyances Charges 997162 18% 500.00 3 CGST 495.00 4 SGST 495.00 Total 6,490.00 Amount Chargeable (in words) E.&0.E Indian Rupees Six Thousand Four Hundred Ninety Only HSN/SAC Taxable Central Tax State Tax Total Value Rate Amount Rate Amount Tax Amount 997162 5,500.00 9% 495.00 9% 495.00 990.00 Total 5,500.00 495.00 495.00 990.00 Tax Amount (in words) : Indian Rupees Nine Hundred Ninety 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 MOHAMMED UVESHV.MALVAT SLA73478 AuthoriSed Signatory A8AD SUBJECT TO AHMEDABAD JURISDICTION ---PAGE END---