Statement of Supply for GST Purpose

SHINE ENTERPRISES ICICI Bank LTD

29-694/11/1/1,DINAKER NAGAR,NERDMET,HYDERABAD,MEDCHAL G-2.SMR VINAY CAPITOR DOORNO 6-3-10BALANAGAR HYDERABAD

MALKAJGIRI,TELANGANA,50005 Telangana
State/ Place of supply:TELANGANA State Code:36
State code:36 GSTIN:36AAACI1195H1ZN
GSTIN/ISDN/UIN:36BROPP2552A1ZU HSN code:997112
Account number/Cust ID:111505002165 Nature of Service:Deposit services

TAXABLE SUPPLIES
GST Invoice Invoice Amount of CGST SGST/UGST IGST KFC Invoice
Transaction ID Particulars
Number Date Charges*(`) @ 9% (`) @ 9% (`) @18% (`) @1%(`) value

May 29, IMPS chrg

0138210645341973 S90500674 5.00 0.45 0.45 0.00 0.00 5.90
2021 Apr-21+GST

Total ( ` ) 5.00 0.45 0.45 0.00 0.00 5.90

Invoice Value In Words Five rupees and ninety paise only

*Amount of charges includes notional value of supply in cases of FC conversion

**Taxes includes Kerala Flood Cess (KFC) as applicable in the state of Kerala.

Corporate Office: ICICI Bank Ltd., ICICI Bank Towers, Bandra-Kurla complex, Mumbai - 400051, India.
Registered Office: ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, Gujarat. Pin – 390 007.
CIN : L65190GJ1994PLC021012
This invoice is issued as per Section 31 of the Central Goods and Services Act. Page: 1 of 1
Customers are requested to Immediately notify the Bank in case of any discrepancy in the invoice