SOUMEN KUMAR MAITY                                          GSTIN No. :    19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                         Bill No. :          90            2021
SLA-54973, Exp. 23-04-2022                                                      Date               31-01-2021
Mobile No.- 9434007542                                                      Report No. :        BAJAJ-90-2021
                                                          SURVEY FEES BILL
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                    Claim No. :          OC-21-2401-1803-00001657
Insured                              ANIL RAY                  Policy No. :          OG-21-2421-1803-00001469
                                                                                                                           Amount
SI. No.                                         Description
                                                                                                                          (in Rupees)
            Survey Fee for final survey WB23D3776                                                                   1,000.00








                                                                               Total Taxable Value                     1,000.00
                                                                                       Add : CGST @ 9%                          90.00
                                                                                       Add : SGST @ 9%                          90.00
                                                                                            Total Value                     1,180.00
       Amount in words :        Rupees One Thousand One Hundred Eighty Only
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :      KHARAGPUR                                                                  SAA- E
A/C Number :      190010100108430                                                             54873
IFS Code               UTIB0000190

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