SOUMEN KUMAR MAITY                                             GSTIN No. :     19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                             Bill No. :           47             2020
SLA-54973, Exp. 23-04-2022                                                         Date                 04.08.2020
Mobile No. -9434007542                                                         Report No. :        BAJAJ-47-2020
                                                                        INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                      Claim No. :           OC-21-2401-1803-00000714
Insured                       MD. MAJNU ANSARY           Policy No. :          OG-21-1529-1803-00001190
                                                                                                                                     Amount
SI. No.                                             Description
                                                                                                                                    (in Rupees)
     1     Survey Fee (As per schedule) Professional fees for final survey of
             WB33C 1218(Assessment Amount Rs.-43,000.00)                                                            1,000.00



     2     Travelling : From Kharagpur to C.K Road Garage and back by
                              own car X 2 by WB36B 9598 (70 km. X 4 X 7.5)                                            2,100.00





                                                                                      Total Taxable Value                       3,100.00
                                                                                              Add : CGST @ 9%                          279.00
                                                                                              Add : SGST @ 9%                          279.00
                                                                                                    Total Value                       3,658.00
        Amount in words :        Rupees Four Thousand Seven Hundred Seventy Nine Only.
BANK DETAILS
Bank Name             AXIS BANK LTD.
Branch Name :       KHARAGPUR                                                                             4973
                                                                                                                             SL
A/C Number :       190010100108430
IFS Code                 UTIB0000190                                                                          SURY

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