SOUMEN KUMAR MAITY                                          GSTIN No. :    19AGRPM4779K2ZB
Surveyor e Loss Assessor                                                        Bill No. :           8             2021
SLA-54973, Exp. 23-04-2022                                                     Date :]          22-02-2021
Mobile No. - 9434007542                                                    Report No. :       BAJAJ-08-2021
                                                                  INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
KOLKATA. R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                  MOTOR                    Claim No. :          OC-21-2401-1803-00002457
Insured           :             NAJRUL KHAN               Policy No. :          OG-21-2410-1803-00000216
                                                                                                                           Amount
SI. No.                                         Description
                                                                                                                          (in Rupees)
    1    Survey Fees (As per schedule) Professional fees for final survey of
            WB33c 5492 (Assessment Amount Rs.-49,000.00)                                                      1,000.00



    2     Travelling : From Kharagpur to Anandapur Garage and back by
                           own car X 2 by WB36B 9598 (42 km. X 4 X 7.5)                                          1,260.00






                                                                                Total Taxable Value                     2,260.00
                                                                                       Add : CGST @ 9%                        203.40
                                                                                       Add : SGST @ 9%                        203.40
                                                                                             Total Value                     2,666.80
       Amount in words :       Rupees Two Thousand Six Hundred Sixty Six Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :      KHARAGPUR                                                                  4973
                                                                                                              SLA
A/C Number :      190010100108430                                                           C
                                                                                                             .
IFS Code               UTIB0000190                                                              SURVE
                     :

---PAGE END---