TAX INVOICE
RAJ KUMAR SINGH
Surveyor & Loss Assessor                                                                          Mobile No.:9415126388
 Licence No.SLA /29063 Valid Upto 06-08-2020                      116/47, Rawatpur,Kanpur-208019
GSTN.09AKUPS9618L1ZX                                                          E-mail : singhrk.knp@gmail.com
STATE BANK OF INDIA KAKADEO KANPUR A/C NO.10404792924 MICR NO.208002044 IFSC-SBIN0003467
Bill No.       343                                                                                 Date:      27/11/2020
Insurer:       Bajaj Allianz General Insurance Co. Ltd
                                                                                   Vehicle No.        UP77V9416
                   11/9,Silver Line
                                                                                   Make               Bajaj Pulser
 GSTN.         09AABCB5730G1ZV
Insured :       Gyanendra Kumar Singh
                   Ward No.10, malviya Nagar, PO-Pukhtayan,
Date of accident :    21/11/2020                                      Policy No.          OG-20-1302-1802-0001242
Date of deputation :23/11/2020                                      Claim No.          OC-21-1302-1802-00001489
     Particulars OF Servies                                                                      SAC              Amount
1.     Final Survey                Estimate Amount                   0.00             997162                      750.00
                                          Assessed Amount                  0.00
2.      Digital Photographs                          0   @  Rs.   0.00 each                                        0.00
3.     Local Conveyance                                                                                                   1,000.00
4.     Re-Inspection Conveyance                                                                                            0.00
5.     Fare from Kanpur to spot and back     0       kms.at Rs.0.00 /Km.                                    0.00
6.      Outstation allowance

7.     toll tax                                                                                                                     220.00
                                                                                          Taxable Value :                     1,970.00
                                                                                          C.G.S.T.@ 9.00%                     177.30
                                                                                          S.G.S.T.@ 9.00%                      177.30
                                                                                          Grand Total                              2,325
 Rs.in Words:TWO THOUSAND THREE HUNDRED TWENTY-FIVE ONLY

E.&O.E                                                                                            (R K SINGH)
 REMARKS:                                                                                Surveyor & Loss Assessor


                                                     ACKNOWLEDGEMENT
Insurer :Bajaj Allianz General Insurance Co. Ltd                            Bill No.343            27/11/2020

Insured :Gyanendra Kumar Singh                                              Veh.No.  UP77V9416

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