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-20-12-123                                                                            INVOICE DATE                                 12-12-20

                                                                               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-21-1301-1826-00001744
             INSURED-        -Sangam
             VEHICLE NO    -UP-45-AJ-1240
             ESTIMATE       -9117.00
             ASESSED        -4472.00
             REMARK -CONVEYANCE FAIZABAD TO AMBEDKAR NAGAR
             =72X2X11.5=1656.00
             PROFESSIONAL FEE                                         9971]       500      1656|      2156|        9%    194.04        9%|   194.04          0          1
             REINSPECTION FEE                                          9971           o          0           o        9%|          0        9%           o          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0|        9%           0          0
             TOTAL                                                                            500|     1656|     2156|                194.04|                194.04                        0

             TOTAL INVOICE VALUE IN FIGURES                                                     2544.08]
             TOTAL INVOICE VALUE IN WORDS                                                       TWO THOUSAND FIVE HUNDRED FORTY FOUR ONLY


                                                                                                                                                                               Shy
                                                                                                                                                                                   KNQW-21

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