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-21-01-500                                                                            INVOICE DATE                                 17-02-21

                                                                              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-21-1302-1843-00000454
             INSURED-        - Vimlesh Kumar Dubey
             VEHICLE NO    -UP-72-BD-1376
             ESTIMATE       -14890.00
             ASESSED        -4814.00
             REMARK PRATAPGARH TO ALLAHABAD 40X2X6.5=520
             PROFESSIONAL FEE                                        9971]       750[       520      1270|        9%|     114.3        9%|     114.3|          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                                                                           750|      520|     1270|                 114.3                 114.3|                       0

             TOTAL INVOICE VALUE IN FIGURES                                                       1498.6
             TOTAL INVOICE VALUE IN WORDS


                                                                                                                                                                             Shy
                                                                                                                                                                                EKNQW-21

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