SOUMEN KUMAR MAITY                                           GSTIN No. :    19AGRPM4779K2ZB
 Surveyor  Loss Assessor                                                           Bill No. :         212           2020
SLA-54973, Exp. 23-04-2022                                                       Date                11-12-2020
Mobile No. - 9434007542                                                       Report No. :       BAJAJ-212-2020
                                                            SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                     Claim No. :           OC-21-2401-1803-00001919
                                              UNUS ALI                                                  OG-21-3045-1803-00000031
Insured                                                                  Policy No. :
 SI. No.                                                                                                                  Amount
                                                      Description
                                                                                                                              (in Rupees)
    1     Survey Fee for final survey of WB25G2246                                                                 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/CNumber :      190010100108430
IFS Code                UTIB0000190                                                                         M
                                                                                                                      n
MICR Code            721211102                                                                  (sigharu)a

---PAGE END---