SOUMEN KUMAR MAITY                                             GSTIN No. :    19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                             Bill No. :           75             2020
SLA-54973, Exp. 23-04-2022                                                         Date                15-10-2020
Mobile No. - 9434007542                                                        Report No. :        BAJAJ-75-2020
                                                                       INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                      Claim No. :           OC-21-2401-1828-00000478
Insured                         SUMANTA METYA             Policy No. :           OG-20-3042-1828-00000086
                                                                                                                                    Amount
SI. No.                                            Description
                                                                                                                                   (in Rupees)
     1     Survey Fees (As per schedule) Professional fees for final survey of
             WB30AD 4745 (Assessment Amount Rs.-3,000.00)                                                            500.00



            Travelling : From Kharagpur to Khadinan More Garage and back by
                            own car X 1 by WB36B 9598 (76km.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
                                                                                                                             4973
A/C Number :       190010100108430
IFS Code                UTIB0000190
                               721211102                                                                      (Signature)

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