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)
PAN : ACWPT4121D                                                                                Near New Bus Stand,SHAHADOL (MP)
GST No.: 23ACWPT4121D1ZM                                                                                SHAHADOL (MP) Pin 484O01
Bank of Baroda A/C No-12930100005566                                                               email.: rakeshsdl@yahoo.co.in
IFCS Code Number-BARBOSOHAGP
MICR Code Number-484012001
INVOICE NO. :       RT/7953
                                                                                                                                                Date: 23/03/2021
                                                                    TAX CREDIT INVOICE
BILLEd tO.
THE CLAIMS MANAGER                                                                                         23AABCB5730G1Z5
                                                                                                   BUY. GSTIN NO
Bajaj Allianz General Insurance Co Ltd, BHOPAL                                PAN No. :           AABCB5730G
BHOPAL(MP)
                                                                                                   PLACE OF SUPPLYBHOPAL (MP)
BHOPAL (MP)                   M P                       INDIA
                                                                                                   STATE OF SUPPLYM P
PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
Vehile Number                                       MP54CA0866
INSURED                                               MR RAJ KOL
                                                    :
POLICY NO.                                            OG-21-3373-1870-00000032
                                                    :
Claim Number                                :      OC-21-2301-1870-00000505
DATE OF SURVEY                             :      20/01/2021-
PLACE OF SURVEY                                   M/s. Gupta Automobiles UMARIYA (MP)
 DESCRIPTION OF SERVICE CHARGES                                                                                             AMOUNT
PROFESSIONAL SURVEY FEES         Assessed Amount                  Rs.                 135177             Rs.                       2500.00

 CONVEYENCE: By Car                          150        KMS.      @      Rs.             7.50              Rs.                       1125.00
LOCAL PETROL RATE                           71.71       /Its
                              Shahdol to UMARIYA & Back By Car MP18CA6069
CONVEYANCE: LOCAL AT SDL                                                                                              Rs.                            9.00
                                                                                                                                     Rs.
HALTING ALLOWANCE                           Per day @750/-                                                       Rs.                            0.00
PHOTOGHRPHS :                                   0          Nos        @      Rs.            40.00              Rs.                             0.00

DTHERS :                                                                                                                        Rs.                             0.00
                                                 SUB TOTAL TAXABLE                                                        Rs.                       3634.00
     HSN / SAC                                                                         CGST     @            9%        Rs.                         327.00
       CODE :        TAXES (00440169) GST No.: 23ACWPT4121D1ZM      SGST     @            9%        Rs.                         327.00
       997162                                                                            IGST      @            0%       .Rs.                            0.00
                                                                                         TOTAL AMOUNT WITH TAX -         Rs.                       4288.00
       Amount In Words :        RS.FOUR THOUSAND TWO HUNDRED EIGHTY EIGHT ONLY.
      HSN/SAC          TAXABLE                 CENTRAL TAX                        STATE TAX                          INTERSTATE TAX
        CODE               VALUE              RATE            AMOUNT         RATE          AMOUNT             RATE               AMOUNT
        997162             3634.00               9%              327.00          9%            327.00              0%                   0.00
   TOTAL tAX Rs.          654.00      RS. SIX HUNDRED FIFTY FOUR ONLY.

 3-03-2021
                                                                                                                                                          RAKESH TRIVEDI
  & O.E - Subject to Shahdol (MP) Jurisdiction.                                                                5 Licence No. 8

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