SOUMEN KUMAR MAITY                                             GSTIN No. :     19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                             Bill No.           75             2020
SLA-54973, Exp. 23-04-2022                                                          Date                21.10.2020
Mobile No. - 9434007542                                                         Report No. :        BAJAJ-75-2020
                                                              SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :           OC-21-2401-1803-00001309
Insured                         SK SUKUR KAYAL             Policy No. :          OG-21-2467-1803-00000028
                                                                                                                                  Amount
SI. No.                                           Description
                                                                                                                                  (in Rupees)
            Survey Fee for final survey of WB41G 9459                                                                  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
A/C Number :       190010100108430                                                                 KUM
IFS Code                UTIB0000190
                                                                                                                       SLA  1973
MICR Code             721211102                                                                         gnatur

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