SOUMEN KUMAR MAITY                                           GSTIN No. :    19AGRPM4779K2ZB
 Surveyor  Loss Assessor                                                          Bill No.:          36            2020
SLA-54973, Exp. 23-04-2022                                                      Date                20.06.2020
 Mobile No. - 9434007542                                                      Report No. :        BAJAJ-36-2020
                                                                    INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                    Claim No. :           OC-21-2401-1803-00000262
Insured                          SOUMEN MAITY              Policy No. :          OG-20-3389-1803-00000036
                                                                                                                              Amount
SI. No.                                          Description
                                                                                                                              (in Rupees)
            Survey Fee (As per schedule) Professional fees for final survey of
             WB29B 3809(Assessment Amount Rs.-20,000.00)                                                           750.00



     2     Travelling : From Kharagpur to Mechogram Garage and back by
                             own car X 2 by WB36B 9598 (65km.X 4 X 7.5)                                           1,950.00





                                                                                  Total Taxable Value                      2,700.00
                                                                                         Add : CGST @ 9%                        243.00
                                                                                         Add : SGST @ 9%                        243.00
                                                                                               Total Value                      3,186.00
       Amount in words :       Rupees Three Thousand One Hundred Eighty Six Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.                                                          KUMAR
Branch Name :       KHARAGPUR
A/C Number        190010100108430                                                        SLA-54973
IFS Code                                                                                                   Th
                              UTIB0000190                                                            0

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