SURVEY FEE BILL


SHYAM & CO.                                                                                                                 Address-:
SURVEYOR & LOSS ASSESSOR - LICENSE NO -27416, VALID TILL -24-03-2023                            MMIG-14,SEC-A, Sitapur Road Scheme, Aliganj , Lucknow
GSTIN NO-09AEZPP7123A1Z7                                                                                             09919280888, 09829833399
PAN NO -AEZPP7123A                                                                                                  radheyrspandey9@rediffmail.com

Billing Address
Bajaj Allianz General Insurance Co. Ltd.
GSTIN NO 09AABCB5730G1ZV
15/54-B,2nd Floor,Virendra Smrati Complex, Civil Lines, Kanpur-208001, (U.P.)
Place of Supply                   Lucknow
INVOICE NO         SC-21-01-283                                                                            INVOICE DATE                                 30-01-21

                                                                               HSN                    CONV.    TAXABLE
SNO      ITEM DESCRIPTION                                       CODE     FEE      CHARGE VALUE             CGST                  SGST                  IGST
             INSURANCE CLAIMS ADJUSTMENT
             SERVICES                                                                                                        RATE %    AMT    RATE %    AMT    RATE %    AMT
                                  DETAIL OF CLAIM
             CLAIM NO        -OC-21-1301-1826-00002209
             INSURED-        -KAMLESH
             VEHICLE NO    -UP-41-AX-7855
             ESTIMATE       -8542.00
             ASSESSED      -3313.00
             REMARK-LUCKNOW TO BARABANKI=27X2X11.5=621
             PROFESSIONAL FEE                                         9971]       500       621      1121        9%    100.89        9%|   100.89          0          1
             REINSPECTION FEE                                         9971           o          0           o        9%|          0        9%           o          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0        9%           0          0
             TOTAL                                                                            500|       621     1121                100.89|                100.89                       0

             TOTAL INVOICE VALUE IN FIGURES                                                     1322.78
             TOTAL INVOICE VALUE IN WORDS


                                                                                                                                                                              Shy
                                                                                                                                                                                   KNQW-21

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