TAX INVOICE

Details of Receiver (Billed To) Details of Supplier (billed by)

Kotak Mahindra General Insurance
GSTIN/UIN Name :
Company Limited
Customer ID 1009168679 GSTIN : 09AAFCK7016C1ZR
Customer Name ASHISH GUPTA Pan Number : AAFCK7016C
Email ID VIPIN0103@GMAIL.COM CIN: U66000MH2014PLC260291
4Th Floor, Block-A-401Rohit BhavanSapru
Contact No 8127371111 Address:
MargLucknow Uttar Pradesh 226001.
E-2/ 675, SECTOR F, JANKIPURAM,
Address LUCKNOW, 226021, UTTAR PRADESH, Date of Invoice 06/12/2023
India
IMD Code 6498880000 Invoice No 2755262301
Receipt No 1202401173537 Proposal No 202312060056344
Partner Application No 2755262300
State Code 09 State Code: 09
Place Of Supply Name UTTAR PRADESH - 09 State Name UTTAR PRADESH
IRN

HSN / SAC Total Value of Supply Taxable value of Supply CGST CGST Amt SGST SGST Amt
HSN/SAC Description
Code (Rs.) (Rs.) Rate (Rs.) Rate (Rs.)
997133 15845.37 15845.37 9% 1,426.08 9% 1,426.08
Health insurance services
Total 15845.37 15845.37 1426.08 1426.08
Total Invoice Value (In
18,698.00
Figure)
Total Invoice Value (In
Eighteen Thousand Six Hundred Ninety Eight
Words)
Whether Tax Payable on a Reverse Basis or Not No

For : Kotak Mahindra General Insurance Company Limited

Authorized Signatory

"I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified
under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule."

Kotak Mahindra General Insurance Company Limited

CIN: U66000MH2014PLC260291, Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra East, Mumbai ­ 400051. Maharashtra, India.
Office: 8th Floor, Zone IV, Kotak Infinity, Building No.21, Infinity IT Park, Off Western Express Highway, General AK Vaidya Marg, Dindoshi, Malad(E), Mumbai ­ 400097. India.
Toll Free: 1800 266 4545 Email:care@kotak.com Website: www.kotakgeneral.com IRDAI Reg. No. 152