RAKESH TRIVEDI
                                                                                                                                                     Mobile no-9425180732 &
    SURVEY6R/ LOSS ASSESSOR
    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 484001
   Bank of Baroda A/C No-12930100005566                                                                       email.: rakeshsdl@yahoo.co.in
   IFCS Code Number-BARB0SOHAGP
  MICR Code Number-484Q12QQ1
  INVOICE NO. :        RT/6821                                                                                                                        Date: 22/09/2020
                                                                            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 SUPPLYBHOPAL (MP)
 BHOPAL (MP)                     M P                         INDIA                       STATE OF SUPPLYM P
 PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
 Vehile Number                                  :      MP18SA1354
 INSURED                                           :      MR SHIVANAND GUPTA
  POLICY NO.                                                 OG-20-9906-1871-00000475
  Claim Number                                    :      OC-21-2301-1871-00000014
 DATE OF SURVEY                                        21/09/2020-
  PLACE OF SURVEY                                       M/s Manoj Automobiles, Shahdol (MP)
 DESCRIPTION OF SERVICE CHARGES                                                                                                      AMOUNT
 PROFESSIONAL SURVEY FEES         Assessed Amount                    Rs.                     2060                Rs.                           500.00
                                                                                                                                                 Rs.
 CONVEYENCE : By Car                              0           KMS.       @      Rs.              7.50                Rs.                               0.00
 LOCAL AETROL RATE                             71.71        /Its
                              Shahdol to UMARIYA (MP) & Back By Car MP18CA0469
 CONVEYANCE: LOCAL AT SDL               LOCAL AT SHAHDOL                                                           Rs.                           250.00
                                                                                                                                                 Rs.
 HALTING ALLOWANCE                             Per day @750/-                                                            Rs.                               0.00
 PHOTOGHRPHS :                                     1           Nos        @      Rs.              40.00               Rs.                             40.00
OTHERS :                                                                                                                                 Rs.                               0.00
                                                    SUB TOTAL TAXABLE                                                             Rs.                           790.00
       HSN / SAC                                                                              CGST     @             9%         Rs.                             71.00
         CODE :        TAXES (00440169) GST No.: 23ACWPT4121D1ZM       SGST     @             9%         Rs.                             71.00
         997162                                                                                IGST      @             0%         Rs.                               0.00
                                                                                               TOTAL AMOUNT WITH TAX -         Rs.                           932.00
        Amount In Words :         RS. NINE HUNDRED THIRTY TWO ONLY.
       HSN/SAC           TAXABLE                  CENTRAL TAX                          STATE TAX                            INTERSTATE TAX
         CODE               VALUE               RATE             AMOUNT         RATE           AMOUNT             RATE                AMOUNT
        997162               790.00                9%                71.00            9%             71.00                0%                    0.00
   TOTAL TAX RS.          142.00      RS. ONE HUNDRED FOURTY TWO ONLY.

                                                                                                                                                  TR             RAKESH TRIVEDI
                                                                                                                                                    SURVEYOR/LOSS ASSESSOR
& O.E - Subject to Shahdol (MP) Jurisdiction.                                                                             *  Licence No.
                                                                                                                                               16997

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