GSTIN 09ADCPC7373H1ZJ Mob - 9415210795
RAJESH CHANDRA
GOVT. APPROVED SURVEYOR & LOSS ASSESSOR
Licence No. SLA 15141
Valid Up to 23-Mar-2020
SURVEY FEE BILL
Document No. RC/BAGIC/2020-21/1143 Reserve Charge No
Date of Issue 30/03/2021 Place of Supply Gorakhpur
Details of Receiver | Billed to: Details of Consignee | Shipped to:
Name Bajaj Allianz General Insurance Co. Ltd. Name Bajaj Allianz General Insurance Co. Ltd.
Address Bank Road, Gorakhpur Address Bank Road, Gorakhpur
GSTIN 09AABCB5730G1ZV GSTIN 09AABCB5730G1ZV
State Uttar Pradesh State Code 09 State Uttar Pradesh State Code 09
CLAIM NUMBER : 0C-21-1301-1871-00000484
DATE OF LOSS : 27/03/2021
POLICY NUMBER : 0G-21-1303-1871-00000625
PERIOD OF INSURANCE : From 14/03/2-020 To 13-Mar-2021
ESTIMATED LOSS : 30000.00
VEHICLE NO : UP 57 AV 5490
INSURER : Bajaj Allianz General Insurance CO LTd
INSURED : ROSHAN SAHANI
Sr. No. Description HSN/SAC Amounts [In Rs.}
1 Professional Suryey Fee 500.00
Conveyance Expenses From Gorakhpur Kushinagar and back, i.e., 996172
2 750.00
2 *50 =100 @ 7.50 Per Km by Car No UP 53 AA 0419
3 Photographs Expenses 50.00 s
Total 1300.00
Total Invoice Amount in Words: Total Amount Before Tax 1300.00
Rs. One Thousand Five Hundred Thirthy Four Add : CGST @ 09% 117
Add : UGST @ 09% 117]
Add : IGST 0.00
Tax Amount : GST 234
Bank Details Total Amount After Tax 1534.00
Bank Name : UNITED BANK OF INDIA
A/c No. : 0497010064912
MICR No : 273027002
IFS Code : UTBI0GRR519
Terms and Conditions :
RAJESH CHANDRA
Surveyor & Loss Assessor
Office Cum Residance
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