SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                           Bill No. :          124           2020
SLA-54973, Exp. 23-04-2022                                                        Date                17-11-2020
Mobile No.- 9434007542                                                       Report No. :       BAJAJ-124-2020
                                                            SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                     Claim No. :           OC-21-2401-1803-00000648
Insured                          UTTAM MAITY               Policy No. :
                                                                                                           OG-20-2401-1803-00017898
                                                                                                                              Amount
SI. No.                                          Description
                                                                                                                              (in Rupees)
            Survey Fee for final survey of  WB15D 0698                                                                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/CNumber :                                                                                                  3
                             190010100108430
                                                                                                                     SLA-54973]
IFS Code       :       UTIB0000190
                                                                                                                                 0

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