SOUMEN KUMAR MAITY                                            GSTIN No. :     19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                            Bill No. :          132            2021
SLA-54973, Exp. 23-04-2022                                                         Date                30-03-2021
Mobile No. - 9434007542                                                         Report No. :       BAJAJ-132-2021
                                                                     FEES BILL
Bajaj Allianz General Insurance Co. Ltd.
Kolkata R.O
GSTIN NO-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :      OC-21-2401-1803-00002897
Insured                             ERFAN SEKH                 Policy No. :     OG-21-3378-1803-00000190
                                                                                                                                 Amount
SI. No.                                           Description
                                                                                                                                 (in Rupees)
            Survey Fee  for final survey WB51C 2114                                                                     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                                                              SLA-
IFS Code                UTIB0000190                                                                   54973
                      :

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