SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                           Bill No. :          87            2020
SLA-54973, Exp. 23-04-2022                                                       Date               29-12-02020
Mobile No. - 9434007542                                                       Report No. :        BAJAJ-87-2020
                                                                     INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :           OC-21-2401-1826-00001180
Insured                          ARCHANA PORE              Policy No. :          OG-20-3042-1826-00000841
                                                                                                                                Amount
SI. No.                                           Description
                                                                                                                               (in Rupees)
            Survey Fees (As per schedule) Professional fees for final survey of
             WB50Q 7167(Assessment Amount Rs.-24,500.00)                                                         1,000.00



     2     Travelling : From Kharagpur to Sreebora Garage and back by
                           own car X 1 by WB36B 9598 (65 km. X 2 X 7.5)                                              975.00





                                                                                   Total Taxable Value                      1,975.00
                                                                                           Add : CGST @ 9%                         177.75
                                                                                           Add : SGST @ 9%                         177.75
                                                                                                Total Value                      2,330.50
       Amount in words :       Rupees Two Thousand Three Hundred Thirty Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :       KHARAGPUR
A/C Number :       190010100108430
IFS Code                UTIB0000190

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