SURVEY FEE BILL

SHYAM & CO.                                                                                                                Address-:
SURVEYOR & LOSS ASSESSOR - LICENSE NO -27416, VALID TILL -24-03-2023                            MMIG-14,SEC-A, Sitapur Road Scheme, Aliganj , Lucknow
GSTIN NO-09AEZPP7123A1Z7                                                                                            09919280888, 09829833399
PAN NO -AEZPP7123A                                                                                                  radheyrspandey9@rediffmail.com

Billing Address
Bajaj Allianz General Insurance Co. Ltd.
GSTIN NO 09AABCB5730G1ZV
15/54-B,2nd Floor,Virendra Smrati Complex, Civil Lines, Kanpur-208001, (U.P.)
Place of Supply                   Lucknow
INVOICE NO         SC-21-03-113                                                                            INVOICE DATE                                 27-03-21

                                                                               HSN                    CONV.    TAXABLE
SNO      ITEM DESCRIPTION                                       CODE     FEE      CHARGE VALUE             CGST                 SGST                  IGST
             INSURANCE CLAIMS ADJUSTMENT
             SERVICES                                                                                                       RATE %    AMT    RATE %    AMT    RATE %    AMT
                                  DETAIL OF CLAIM
             CLAIM NO        -OC-21-1301-1826-00002817
             INSURED-        -AMIT KUMAR GUPTA
             VEHICLE NO    -UP-41-AW-5499
             ESTIMATE       -28516.00
             ASESSED       -11530.00

             PROFESSIONAL FEE                                         9971       750[       350|      1100|        9%|         99|        9%|         99|          0          1
             REINSPECTION FEE                                         9971       350|       150       500        9%|        45|        9%         45|          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0        9%           0          0
             TOTAL                                                                          1100|       500|     1600|                    144                    144                       0

             TOTAL INVOICE VALUE IN FIGURES                                                         1888
             TOTAL INVOICE VALUE IN WORDS


                                                                                                                                                                             Shy
                                                                                                                                                                                 EKNQW-21

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