SOUMEN KUMAR MAITY                                              GSTIN No. :     19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                              Bill No. :-           50             2021
SLA-54973, Exp. 23-04-2022                                                           Date                28-01-2021
Mobile No. - 9434007542                                                          Report No. :        BAJAJ-50-2021
                                                               SURVEY FEES BILL
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                    MOTOR                      Claim No. :           OC-21-2401-1803-00002192
Insured                            ABDUL MONDAL               Policy No. :          OG-21-2421-1803-00000500
SI. No.                                                                                                                        Amount
                                                         Description
                                                                                                                                    (in Rupees)
             Survey Fee for final survey WB25G1986                                                                         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
Bank Name             AXIS BANK LTD.                                                                 Ky  AR
                                                                                                                        EN
Branch Name :       KHARAGPUR                                                                       $
A/CNumber :                                                                                                   54973
                               190010100108430
IFS Code                 UTIB0000190

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