SOUMEN KUMAR MAITY                                            GSTIN No. :    19AGRPM4779K2ZB
Surveyor & Loss Assessor                                                           Bill No.:          59            2020
SLA-54973, Exp. 23-04-2022                                                       Date                03.09.2020
Mobile No. - 9434007542                                                       Report No. :        BAJAJ-59-2020
                                                                     INVOICE
To
BAJAJ ALLIANZ GENERAL INSURANCE CO.LTD.
KOLKATA.R.O,KOLKATA
GSTIN NO:-19AABCB5730G1ZU
Nature of Claim:                   MOTOR                     Claim No. :           OC-21-2401-1826-00000476
Insured                         ABHISEK DOLAI             Policy No. :          OG-20-3042-1826-00000431
SI. No.                                                                                                                    Amount
                                                      Description
                                                                                                                                (in Rupees)
            Survey Fees (As per schedule) Professional fees for final survey of 
            WB30AE 3624(Assessment Amount Rs.-14,000.00)                                                          750.00



    2     Travelling : From Kharagpur to Khanyadihi Garage and back by
                           own car X 2 by WB36B 9598 (66km.X 4 X 7.5)                                             1,980.00





                                                                                   Total Taxable Value                      2,730.00
                                                                                          Add : CGST @ 9%                         245.70
                                                                                           Add : SGST @ 9%                         245.70
                                                                                                Total Value                      3,221.40
       Amount in words :       Rupees Three Thousand Two Hundred Twenty One Only.
BANK DETAILS
Bank Name            AXIS BANK LTD.
Branch Name :       KHARAGPUR
A/C Number :       190010100108430
                                                                                                                                 6
IFS Code       :       UTIB0000190

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