SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor &f Loss Assessor                                                            Bill No.:          54            2021
SLA-54973, Exp. 23-04-2022                                                         Date                29-01-2021
Mobile No. - 9434007542                                                        Report No. :        BAJAJ-54-2021
                                                             SURVEY FEES BILL
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                     Claim No. :          OC-21-2401-1803-00002294
Insured                         ANISUR RAHAMAN             Policy No. :          OG-21-2401-1803-00009015
                         :
SI. No.                                           Description                                                      Amount
                                                                                                                                (in Rupees)
            Survey Fee for final surveyWB25G2989                                                                       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/C Number :      190010100108430
IFS Code                UTIB0000190
                                                                                                                  EN
                                                                                                                               M

---PAGE END---