SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor e Loss Assessor                                                          Bill No. :          91            2020
SLA-54973, Exp. 23-04-2022                                                       Date :]           23.11.2020
Mobile No. - 9434007542                                                      Report No. :        BAJAJ-91-2020
                                                                     INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
KOLKATA. R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                     Claim No. :           OC-21-2401-1803-00001544
Insured           :             NARAN GHOSH               Policy No. :          OG-21-2410-1803-00000545
                                                                                                                               Amount
SI. No.                                           Description
                                                                                                                               (in Rupees)
     1     Survey Fees (As per schedule) Professional fees for final survey of
            WB50R 2339 (Assessment Amount Rs.-25,500.00)                                                       1,000.00



     2     Travelling : From Kharagpur to Temathani Garage and back by
                            own car X 1 by WB36B 9598 (33km. X 2 X 7.5)                                               495.00





                                                                                   Total Taxable Value                      1,495.00
                                                                                           Add : CGST @ 9%                         134.55
                                                                                           Add : SGST @ 9%                         134.55
                                                                                                Total Value                      1,764.10
        Amount in words :       Rupees One Thousand Seven Hundred Sixty Four Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :      KHARAGPUR                                                                SLA  4973}I
A/C Number :       190010100108430                                                              c
                                                                                                                    G
                                                                                                                             YOR
IFS Code       :       UTIB0000190

---PAGE END---