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-21-01-405                                                                            INVOICE DATE                                 27-01-21

                                                                               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-21-1302-1826-00002702
             INSURED-         -Raghavendra Nishra
             VEHICLE NO    -UP-70-FF-9414
             ESTIMATE       -4445.00
             ASSESSED      -3281.00
             REMARK-
             PROFESSIONAL FEE                                         9971]       500       250|       750|        9%|      67.5|       9%|      67.5|          0          1
             REINSPECTION FEE                                         9971           o          0          o        9%|          0       9%|          0          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0|        9%          0          0
             TOTAL                                                                           500|       250|       750|                   67.5[                  67.5[                       0

             TOTAL INVOICE VALUE IN FIGURES                                                           885|
             TOTAL INVOICE VALUE IN WORDS                                                      EIGHT THOUSAND EIGHT FIVE


                                                                                                                                                                             Shy
                                                                                                                                                                                 DKNQW-21

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