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-20-11-161                                                                            INVOICE DATE                                 20-11-20

                                                                               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-21-1301-1828-00000273
             INSURED-        - Chandra pal
             VEHICLE NO    - UP-30-AY-6087
             ESTIMATE       - 11884.00/-
             ASESSED       - 4319.00/-
             REMARK -
             PROFESSIONAL FEE                                         9971]       500       250       750        9%|      67.5[       9%|      67.5|          0          1
             REINSPECTION FEE                                         9971           o       150        150|        9%|       13.5|        9%       13.5|          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%|          0        9%          0          0
             TOTAL                                                                            500|       400|       900|                     81                     81                       0

              TOTAL INVOICE VALUE IN FIGURES                                                          1062
             TOTAL INVOICE VALUE IN WORDS                                                      ONE THOUSAND SIXTY TWO ONLY


                                                                                                                                                                              Shy
                                                                                                                                                                                  DKNQW-21

---PAGE END---