SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                           Bill No. :          16            2021
SLA-54973, Exp. 23-04-2022                                                       Date :           14-01-2021
Mobile No. - 9434007542                                                       Report No. :        BAJAJ-16-2021
                                                           SURVEY FEES BILL
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                     Claim No. :          OC-21-2401-1803-00000014
Insured                         HASMUKH JOSH              Policy No. :          OG-20-2202-1803-00003595
                                                                                                                             Amount
SI. No.                                          Description
                                                                                                                             (in Rupees)
            Survey Fee for final survey NL01L 7961                                                                      1,000.00








                                                                           UX
                                                                           Le
                                                                                  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.
                                                                                                                  JEN
Branch Name :      KHARAGPUR                                                                   SLA-
A/C Number :      190010100108430                                                             A87
IFS Code       :       UTIB0000190
MICR Code           721211102                                                                   (Signature)

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