TAX INVOICE                                                                 ORIGINAL
                                                                                                                                                                                                          For Recipient
                         ASHIRWAD BANERJEE
                         PURE SAMLA COLLIERY,OFFICE                                                                                    GSTIN 19BENPB0624M1ZE Invoice Date    30/03/2021
                         PARA,P.O:-
                                                                                                                                                          State    19-West Bengal        Invoice No.          GST3847
                         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 30/03/2021

INSURED NAME MR JAHANGIR MOLLICK                         VEHICLE NUMBER WB-44-J-3524                                    CLAIM NUMBER 0C-21-2401-1820-00000001
POLICY NUMBER 0C-21-2420-1820-00000001                    PLACE OF SUPPLY DURGAPUR

        Item                                                    HSN /        Quantity  Rate / Item     Discount     Taxable Value    CGST ()  SGST / UTGST   CESS          Total ()
                                                                   SAC                       (3)               (c)             (2)                                 ()                  (Z)
  1. FINAL SURVEY FEES                         997162  1.00         3,000.00         0.00        3,000.00     270.00             270.00     0.00         3,540.00
                                                                                                                                                                   @9%               @9%
 2. CONVEYANCE TO BANERJEE           997162  1.00           300.00         0.00          300.00       27.00              27.00     0.00           354.00
        FORD (LOCAL)                                                                                                                                   @9%               @9%
                                                                                                          Total                         3,300.00  297.00          297.00     0.00        3,894.00

                                                                                                                                                                                    Taxable Amount                 3,300.00
                                                                                                                                                                                             Total Tax                   594.00
                                                                                                                                                                                 Total Value      ? 3,894.00

                                                                                                                            Total amount (in words)      Three Thousand Eight Hundred Ninety Four Rupees Only

                                                                                                                                                                                                     For ASHIRWAD BANERJEE


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

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