TAX INVOICE
MINESH VALLABHDAS SHAH                                      LICENCE NO.-SLA/63819
Surveyor-Loss Assessors-Valuer-Investigator            EXP.DATE :26/04/2021
FIRE-MOTOR-MARINE (C)-ENGINEERING -MISC.                        IIISLA MEMBERSHIP NO.: F/W/01143
CONTACT :98240 32094                                                     Email: mvshah2@gmail.com
OFFICE:9723815456-BARODA                                                        mvshah2@rediffmail.com
OFFICE : 9824444179-BHARUCH
GSTIN NO.   24AHNPS2949A1ZA                                      PAN No.:AHNPS2949A
  INVOICENO.   1416/20-21                                                   DATE:    22-Oct-20

BILLED TO,
M/s. Bajaj Allianz General Insurance Co. Ltd                  BUY.GSTIN NO           24AABCB5730G1Z3
4th Floor,Atlantis Hetitage, B/h Atlantis Heights          PAN No.:                 AABCB5730G
Opp. Swagat petrol pump, Sarabhai Main Road,            PLACE OFSUPPLY:  GUJARAT
Baroda.                       GUJARAT                  INDIA           STATE OF SUPPLY :  GUJARAT
PROFESSIONAL SERVICES RENDERED FOR THE FOLLOWING,
 OURJOB REF.NO.                                  #20100306
 INSURED/Vehicle No.                           MR.MAKSUDBHAI BHATTI/GJ 16X 9892
 POLICY NO./Claim no.                          OG-21-2225-1803-00001317 /OC-21-2201-1803-00000156
 DATE OF SURVEY                                    13/10/2020 AT SPOT 14/10/2020 FINAL
PLACE OF SURVEY                                  AT SPOT NR JAMBUSAR AND KGN AUTO JAMBUSAR
 DESCRIPTION OF SERVICE CHARGES                                                                             AMOUNT
PROFESSIONAL SURVEY FEES:     ASSESSED LOSS Rs.70000.00+SPOT                   Rs.               2250.00
 CONVEYENCE (TO& FRO):                 210     KMS.  @   Rs.            7.50           Rs.               1575.00
 HALTING ALLOWANCE :                          (SPOT 100KM + FINAL 110KM)            Rs.                     0.00
 PHOTOGHRPHS/CD@40/-:              1       NOS.  @   Rs.           40.00           Rs.                   40.00
 OTHERS(INCEDENTALIF ANY):                                                                                Rs.                     0.00
 SUB TOTAL TAXABLE :                                                                                           Rs.               3865.00
      HSN/SAC                                                                         CGST     @         9%  Rs.                  348.00
         CODE                         TAXES (00440169)                     SGST     @         9%  Rs.                  348.00
         997162                                                                           IGST      @         0%  Rs.                     0.00
                                                                                 TOTAL AMOUNT WITH TAX -   Rs.               4561.00
    Amount In Words :    FOUR THOUSAND FIVE HUNDRED SIXTY ONE ONLY
       HSN/SAC            TAXABLE            CENTRAL TAX                STATE TAX               INTERSTATE TAX
         CODE                 VALUE             RATE      AMOUNT       RATE        AMOUNT        RATE        AMOUNT
         997162               3865.00             9%         348.00         9%          348.00          0%            0.00
   TOTAL TAX RS.           696.00        SIX HUNDRED NINETY SIX ONLY
                                                                                   St
 BANK DETAILS FOR PAYMENT
 BANK NAME :       BANK OF BARODA
 BRANCH       :      AKOTA
                                                                                                               MINESH V.SHAH
 IFSCCODE    :      BARBOAKOTAX                                                          (SURVEYOR / LOSS ASSESSOR)
                                                                                                                                                       GISLA
                                                                                                               LIC.No.SLA 63819/18-21          79-18-21
 MICR CODE           390012021                                                                                                          RLOSS
 CURRENTA/C.NO.: 06760200000417                      Advance receipt.                        MINESH V.SHAH
 E& O.E-Subject to Vadodara Jurisdiction                                                                   (PROPRIETOR)
ADDRESS : * 101, Kanha Appt.,52, Purshottam Nagar, Urmi Cross Road., Akota, Vadodara -390020

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