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-20-11-105                                                                             INVOICE DATE                                 27-10-20

                                                                                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-21-1301-1801-00001618
             INSURED-        - Raj Kumar Son Of ram
             VEHICLE NO    - UP-51-AH-4164
             ESTIMATE       - 18499.00/-
             ASESSED        -4719.00 /-
             REMARK - CONVEYANCE FAIZABAD TO BASTI DISTANCE
              =64X2X11.5=1472.00
             PROFESSIONAL FEE                                         9971]       500      1472|      1972        9%    177.48        9%|   177.48          0          1
             REINSPECTION FEE                                          9971          0       150       150        9%|      13.5|        9%|      13.5|          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0        9%           0          0
             TOTAL                                                                             500|     1622|     2122|                190.98                190.98|                        0

              TOTAL INVOICE VALUE IN FIGURES                                                      2503.96
             TOTAL INVOICE VALUE IN WORDS                                                       TWO THOUSAND FIVE HUNDRED FOUR ONLY


                                                                                                                                                                                Shy
                                                                                                                                                                                    KNQW-21

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