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
HDFC ERGO General Insurance Company Ltd.
GSTIN NO 09AABCL5045N1Z6
Ratan Square, 20 A, Vidhan Sabha Marg, Lucknow - 226 001

Place of Supply                   Lucknow
INVOICE NO         SC-20-09-320                                                                           INVOICE DATE                               10-10-2020

                                                                              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-21-1302-1802-00001034
             INSURED-       - Narendra Kumar
             VEHICLE NO   - UP-72-AS-1245
             ESTIMATE       - 5500/-
             ASESSED       - No-claim
             REMARK -
             PROFESSIONAL FEE                                        9971]       750[       250|      1000        9%|         90|       9%|         90|          0          1
             REINSPECTION FEE                                         9971          0          0          o        9%|          0       9%          o          0          0
             PROFESSIONAL FEE FOR SPOT                        9971          0          0          0        9%          0        9%          0          0
             TOTAL                                                                           750|       250|     1000|                     90|                     90|                       0

             TOTAL INVOICE VALUE IN FIGURES                                                         1180
             TOTAL INVOICE VALUE IN WORDS                                                     TWO THOUSAND ONE HUNDERED EIGHTY ONLY


                                                                                                                                                                            Shy
                                                                                                                                                                                DKNQW-21

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