SOUMEN KUMAR MAITY                                           GSTIN No. :     19AGRPM4779K2ZB
 Surveyor  Loss Assessor                                                           Bill No. :          46            2020
SLA-54973, Exp. 23-04-2022                                                       Date                22.07.2020
Mobile No. - 9434007542                                                      Report No. :        BAJAJ-46-2020
                                                                     INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                     Claim No. :          OC-11-2401-1803-00000640
Insured                               SK.LATIF                   Policy No. :          OG-20-3385-1803-00000127
                                                                                                                                Amount
SI. No.                                           Description
                                                                                                                               (in Rupees)
     1     Survey Fee (As per schedule) Professional fees for final survey of 
             WB33B 6020(Assessment Amount Rs.-21,000.00)                                                         1,000.00



    2     Travelling : From Kharagpur to Tetultola Garage and back by
                             own car X 1 by WB36B 9598 (28km. X 2 X 7.5)                                             420.00





                                                                                   Total Taxable Value                       1,420.00
                                                                                          Add : CGST @ 9%                         127.80
                                                                                           Add : SGST @ 9%                         127.80
                                                                                                Total Value                      1,675.60
       Amount in words :       Rupees One Thousand Six Hundred Seventy Five Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :      KHARAGPUR
A/C Number :                                                                                                  4973
                              190010100108430                                                           SL
IFS Code                UTIB0000190

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