SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                           Bill No. :         233           2020
SLA-54973, Exp. 23-04-2022                                                        Date                19-12-2020
Mobile No. - 9434007542                                                       Report No. :       BAJAJ-233-2020
                                                            SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :           OC-21-2401-1803-00001539
Insured                            SHAILENDRA SINGH                                             OG-21-2495-1803-00000199
                                                                               Policy No. :
SI. No.                                                                                                                   Amount
                                                      Description
                                                                                                                              (in Rupees)
     1     Survey Fee for final survey of WB11B7335                                                                  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                                                                                                    MAIT
Bank Name            AXIS BANK LTD.
Branch Name :       KHARAGPUR                                                                             .
                                                                                                                        54973
A/C Number :      190010100108430                                                                        g
IFS Code                UTIB0000190                                                                   eSURV

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