SOUMEN KUMAR MAITY                                               GSTIN No. :     19AGRPM4779K2ZB
Surveyor&Loss Assessor                                                               Bill No. :          230            2020
SLA-54973, Exp. 23-04-2022                                                            Date                 18-12-2020
Mobile No. - 9434007542                                                            Report No. :       BAJAJ-230-2020
                                                                SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                    MOTOR                      Claim No. :           OC-21-2401-1803-00001720
Insured                                                                                                      OG-21-2417-1803-00000126
                                         DEBASHISH MAJUMDER               Policy No. :
                                                                                                                                        Amount
SI. No.                                             Description
                                                                                                                                        (in Rupees)
             Survey Fee for final survey of WB23E0560                                                                       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                                                                            4973
                                                                                                                            1t           .
A/C Number :       190010100108430
IFS Code                 UTIB0000190                                                                       6
                                                                                                                                      6
                                                                                                                              SURVEY

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