SOUMEN KUMAR MAITY                                            GSTIN No. :     19AGRPM4779K2ZB
 Surveyor  Loss Assessor                                                            Bill No. :           60             2020
SLA-54973, Exp. 23-04-2022                                                        Date                19/08/2020
 Mobile No.- 9434007542                                                       Report No. :        BAJAJ-60-2020
                                                                       INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
 GSTIN NO:-19AABCB5730G1ZU
 Nature of Claim:                   MOTOR                     Claim No. :           OC-21-2401-1826-00000473
Insured                         AKTAR MAIILCK             Policy No. :          OG-20-3042-1826-00001332
                                                                                                                                   Amount
 SI. No.                                            Description
                                                                                                                                  (in Rupees)
     1     Survey Fees (As per schedule) Professional fees for final survey of
             WB30AF 3196(Assessment Amount Rs.-7,000.00)                                                             500.00



     2     Travelling : From Kharagpur to Khadinan More Garage and back by
                            own car X 1 by WB36B 9598 (76km. X 2 X 7.5)                                             1,140.00






                                                                                     Total Taxable Value                       1,640.00
                                                                                             Add : CGST @ 9%                          147.60
                                                                                             Add : SGST @ 9%                         147.60
                                                                                                  Total Value                       1,935.20
        Amount in words :       Rupees One Thousand Nine HundredThirty Five Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :       KHARAGPUR
A/C Number, :       190010100108430
                                                                                                                       KU
                                                                                                                              C
                                                                                                                     N
IFS Code                UTIB0000190

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