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-21-01-224                                                                            INVOICE DATE                                 21-01-21

                                                                               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-21-1301-1801-00002379
             INSURED-        -SOM NATH
             VEHICLE NO    -UP-44-X-0003
             ESTIMATE       -45968.00
             ASSESSED     -14115.00
             REMARK -LUCKNOW TO BARABANKI=25X2X11.5=575.00
             PROFESSIONAL FEE                                         9971]       750[      575      1325|        9%    119.25        9%|   119.25          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                                                                            750|       725|     1475|                132.75|                132.75|                       0

             TOTAL INVOICE VALUE IN FIGURES                                                       1740.5
             TOTAL INVOICE VALUE IN WORDS                                                      ONE THOUSAND SEVEN HUNDRED FORTY


                                                                                                                                                                               Shy
                                                                                                                                                                                   KNQW-21

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