SOUMEN KUMAR MAITY                                           GSTIN No. :    19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                           Bill No. :          144           2020
SLA-54973, Exp. 23-04-2022                                                        Date                25-11-2020
Mobile No. - 9434007542                                                       Report No. :       BAJAJ-144-2020
                                                            SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :      OC-21-2401-1803-00000558
Insured                         RAZIA ASLAM                                      OG-21-2495-1803-00000012
                                                                               Policy No. :
                                                                                                                              Amount
SI. No.                                          Description
                                                                                                                              (in Rupees)
            Survey Fee for final survey of  WB23D 2972                                                               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                                                                 KUfMAR
A/CNumber :     190010100108430                                                                  A
IFS Code                UTIB0000190                                                                 SLA-34973

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