SURVEY FEE BILL

SHYAM & CO.                                                                                                               Address-:
SURVEYOR & LOSS ASSESSOR - LICENSE NO -27416, VALID TILL -24-03-2023                           MMIG-14,SEC-A, Sitapur Road Scheme, Aliganj , Lucknow
GSTIN NO-09AEZPP7123A1Z7                                                                                           09919280888, 09829833399
PAN NO -AEZPP7123A                                                                                                 radheyrspandey9@rediffmail.com

Billing Address
Bajaj Allianz General Insurance Co. Ltd.
GSTIN NO 09AABCB5730G1ZV
15/54-B,2nd Floor,Virendra Smrati Complex, Civil Lines, Kanpur-208001, (U.P.)
Place of Supply                   Lucknow
INVOICE NO         SC-21-02-189                                                                           INVOICE DATE                                12-02-21

                                                                              HSN                    CONV.    TAXABLE
SNO      ITEM DESCRIPTION                                       CODE     FEE      CHARGE VALUE            CGST                 SGST                  IGST
             INSURANCE CLAIMS ADJUSTMENT
             SERVICES                                                                                                      RATE %   AMT    RATE %    AMT    RATE %   AMT
                                 DETAIL OF CLAIM
             CLAIM NO        -OC-21-1301-1871-00000358
             INSURED-        -NITIN KUMAR
             VEHICLE NO    -UP-30-AX-2270
             ESTIMATE       -5480.00
             ASESSED        -2084.00

             PROFESSIONAL FEE                                        9971]       500|       350|       850|       9%|       76.5       9%|      76.5|          0          1
             REINSPECTION FEE                                         9971                                    o        9%|          0       9%|          o          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0|       9%          0          0
             TOTAL                                                                           500|      350|      850|                  76.5[                  76.5[                       0

             TOTAL INVOICE VALUE IN FIGURES                                                         1003
             TOTAL INVOICE VALUE IN WORDS                                                     ONE THOUSAND THREE ONLY


                                                                                                                                                                            Shy
                                                                                                                                                                               EKNQW-21

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