Rajesh S. Thakker
                                                                                                               C.A.E., D.A.E., A.I.S.A.
                                                                       SURVEYOR, LOSS ASSESSOR & VALUER
                                                                             Licence No. SLA 20725 Exp. Dt. 17-08-2021
                                           5, PATEL COLONY, ROAD NO. 1, OPP. DARSHAN APARTMENT, JAMNAGAR - 361 008, (GUJARAT)
                                                           MO. 98242 11549, 94274 45301 E-mail : rajesh_thakker@rediffmail.com
                                                                                         Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                            Bill. No : RST/203297
      Rajkot                                                                                                                          Date     : 05/02/2021
       1st Floor, Hotel K Rose Building, In Front Of Shastri Medan, Limda Chowk,                            Code     :
       Rajkkot
       GSTIN: 24AABCB5730G1Z3                      State Code: Gujarat (24)
                    Report Ref No                     :     RST/203297
                    Vehicle No.                         :     GJ10Z6149
                    Insured Name                     :     Hamidbhai A Katia
                    Date of accident                  :     20-01-2021
                    Policy/cover note no           :     OG-203299180300000143
                    Claim No                            :    OC-21-2204-1803-00000409

    S No                                               Particulars                                                          HSN/SAC                                      Amount /
      1     Spot                                                                                                                997162                                               2720.00
                       Professional Fee :                                                                                                                 750.00
                       Photos/CD Expenses :                                                                                                            50.00
                        0 Photographs , Charged for 0 @ Rs. 50.00
                       Conveyance Expenses :       Visited total 240 Kms. No of visits 1 charged @28.00/ Km                               1920.00

                                                                                                                                                         Sub Total : 2                  2720.00
                                                                                                                                                     C GST @ 9.00 %                    244.80
                                                                                                                                                     S GST @ 9.00 %                     244.80
                ADVANCE RECEIPT                                                                                                       Grand Total : %                  3209.60
                                                                                                                                                         Round off :                  3,210.00
                                                                  In words : Rs. Three Thousand Two Hundred Ten Only
  GSTIN: 24AAUPT4514C1ZN State : (24)
                                                                                                                                                                        31M0I
   PAN. : AAUPT4514C
                                                                                                                                                                      RAjesh S.ThAKKer
  Bank Name : HDFC Bank Ltd.,                                                                                                                             C.A.e., D.Ae.A..I.S.A.
                                                                                                                                                                       SURVEYCR &LCES ASSESSOR
  A/c No.                : 01771500003760
   MICR No              : 361240001

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