SOUMEN KUMAR MAITY                                         GSTIN No. :    19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                       Bill No. :          7            2021
SLA-54973, Exp. 23-04-2022                                                   Date              17-02-2021
Mobile No. - 9434007542                                                   Report No. :       BAJAJ-07-2021
                                                                INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
KOLKATA. R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                 MOTOR                   Claim No. :          OC-21-2401-1803-00002424
Insured          :      MADHUSUDAN BHANJA       Policy No. :         OG-21-2401-1803-00008790
                                                                                                                       Amount
SI. No.                                        Description
                                                                                                                       (in Rupees)
    1    Survey Fees (As per schedule) Professional fees for final survey of
           WB35 2217 (Assessment Amount Rs.-30,000.00)                                                      1,000.00



    2     Travelling : From Kharagpur to Ghatal Garage and back by
                          own car X 1 by WB36B 9598 (32 km. X 2 X 7.5)                                           480.00





                                                                             Total Taxable Value                     1,480.00
                                                                                    Add : CGST @ 9%                       133.20
                                                                                     Add :SGST @ 9%                       133.20
                                                                                          Total Value                    1,746.40
       Amount in words :      Rupees One Thousand Seven Hundred Forty Six Only.
BANK DETAILS
Bank Name   :      AXIS BANK LTD.
Branch Name :      KHARAGPUR
A/C Number :                                                                                           SLA-
                            190010100108430
                                                                                                                54973
IFS Code      :      UTIB0000190

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