SOUMEN KUMAR MAITY                                             GSTIN No. :     19AGRPM4779K2ZB
Surveyor s Loss Assessor                                                             Bill No. :           54             2020
SLA-54973, Exp. 23-04-2022                                                         Date                 12.09.2020
Mobile No. - 9434007542                                                         Report No. :        BAJAJ-54-2020
                                                                       INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
KOLKATA. R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                    MOTOR                      Claim No. :           OC-21-2401-1802-00000443
Insured                           BISWAJIT DOLAI              Policy No. :           OG-20-2410-1802-00000945
                                                                                                                                    Amount
SI. No.                                            Description
                                                                                                                                    (in Rupees)
     1     Survey Fees (As per schedule) Professional fees for final survey of
             WB34BE5435 (Assessment Amount Rs.-11,000.00)                                                            750.00



     2     Convenyance                                                                                                                1,050.00






                                                                                      Total Taxable Value                       1,800.00
                                                                                              Add : CGST @ 9%                          162.00
                                                                                              Add : SGST @ 9%                          162.00
                                                                                                    Total Value                       2,124.00
        Amount in words :        Rupees Two Thousand One Hundred Twenty Four Only.
BANK DETAILS
Bank Name             AXIS BANK LTD.
Branch Name :       KHARAGPUR
A/CNumber :       190010100108430
                                                                                                                             4973
                                                                                                                       SLA-t
IFS Code                 UTIB0000190                                                                       a     e

---PAGE END---