SURVEY FEE BILL
                      B.N.TIWARI                                                                                                                      Off & Res Address-:
                      SURVEYOR & LOSS ASSESSOR - LICENSE NO -SLA-12166                                                                               SA 17/128-61, Ganpat, Nagar, Pahariya, Varanasi
                      GSTIN NO-09ABRPT8533H1ZV                                                                                                        9415202497
                     PAN NO     -ABRPT8533H                                                                                                          bntiwari.sla@gmail.com
                     Billing Address
                      Bajaj Allianz General Insurance Co. Ltd.
                     GSTIN NO 09AABCB5730G1ZV
                         15/54-B,2ND FLOOR,VIRENDRA SMRATI COMPLEX,
                     CIVIL LINES Kanpur Uttar Pradesh 208001
                     INVOICE NO               BNT/MF/16097/2021                                                                          INVOICE DATE                                     24/05/2021
                                                                                                                            CONV.        TAXABLE
                     SNO          ITEM DESCRIPTION                                           HSN CODE        FEE             CHARGE      VALUE               CGST                     SGST                      IGST
                                  INSURANCE CLAIMS ADJUSTMENT
                                  SERVICES                                                                                                            RATE %        AMT        RATE %        AMT       RATE %         AMT
                                                  DETAIL OF CLAIM
                                  POLICY NO - OG-20-2444-1801-00001612
                                  CLAIM NO - OC-21-1301-1801-00001596
                                  INSURED NAME- AMIT KUMAR KEJRIVAL
                                  VEHICLE NO - BR-01-DC-1818
                                  REMARK
                                  PROFESSIONAL FEE                                                    9971            2500|        250|       2750           9%        247.5          9%       247.5                         0
                                  REINSPECTION FEE                                                    9971             350|        250|         600|         9%           54         9%            54            0           0
                                  EXPENCES (SPOT)                                                     9971                0           0            0|        9%|           0         9%             0
                                  TOTAL                                                                               2850         500|       3350                     301.5|                  301.5|                        0
                                  TOTAL INVOICE VALUE IN FIGURES                                                                               3953
                                  TOTAL INVOICE VALUE IN WORDS                                                                           THERR THOUSAND NINE HUNDRED FIFTY THREE ONLY
                                                                                                                                                                                              2NSom
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