SOUMEN KUMAR MAITY                                            GSTIN No. :     19AGRPM4779K2ZB
Surveyor  Loss Assessor                                                            Bill No. :          159           2020
SLA-54973, Exp. 23-04-2022                                                         Date                28-11-2020
Mobile No. - 9434007542                                                        Report No. :       BAJAJ-159-2020
                                                             SURVEY FEES BILL
To
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :      OC-21-2401-1803-00000137
Insured                                                                                            OG-21-3039-1803-00000015
                                   MANDIRA BHATTACHARJEE          Policy No. :
                                                                                                                                 Amount
SI. No.                                           Description
                                                                                                                                (in Rupees)
            Survey Fee for final survey of WB19J5414                                                                   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.
Branch Name :       KHARAGPUR
A/C Number :      190010100108430                                                           KUA
IFS Code                UTIB0000190                                                                           H

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