SOUMEN KUMAR MAITY                                             GSTIN No. :     19AGRPM4779K2ZB
Surveyor e Loss Assessor                                                             Bill No. :           63             2020
SLA-54973, Exp. 23-04-2022                                                         Date                 11.09.2020
Mobile No. - 9434007542                                                        Report No. :        BAJAJ-63-2020
                                                                       INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
KOLKATA. R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                      Claim No. :           OC-21-2401-1826-00000691
Insured                              TARUN HAIT                  Policy No. :          OG-20-3389-1826-00000665
                                                                                                                                    Amount
SI. No.                                            Description
                                                                                                                                    (in Rupees)
             Survey Fees (As per schedule) Professional fees for final survey of
             WB50Q 7444(Assessment Amount Rs.-3,000.00)                                                                500.00



    2     Travelling : From Kharagpur to Kushpata Garage and back by
                            own car X 1 by WB36B 9598 (76 km. X 2 X 7.5)                                             1,140.00





                                                                                      Total Taxable Value                       1,640.00
                                                                                              Add : CGST @ 9%                          147.60
                                                                                              Add : SGST @ 9%                          147.60
                                                                                                    Total Value                       1,935.20
        Amount in words :        Rupees One Thousand Nine Hundred Thirty Five Only.
BANK DETAILS
Bank Name             AXIS BANK LTD.
Branch Name :       KHARAGPUR                                                                                 M
A/C Number :       190010100108430
                                                                                                                            SLA-$4973
IFS Code                 UTIB0000190                                                                                      .
                                                                                                                                 O
                                                                                                                                       YOR

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