ANUJ KUMAR AGARWAL
                                                                              Surveyor & Loss Assessor                          Tel. 01342-262305
                                                                        License No. SLA 25892, Exp. 09.11.22                    Mob. 9412215972
                                                                   Fellow Member , Dep. Motor, Marine & Engg.                Email a_bijnor@yahoo.com
                                                                                                                                               Add. H.N. 360, State Bank Colony,
                                                                                                                                               Nai Basti, Bijnor-246701

                                                                                      Survey Fee Bill
To,
      Bajaj Allianz General Insurance Co. Ltd.                                                                         Bill. No : B-09/20/00466
      LUCKNOW                                                                                                                 Date     : 27/09/2020
      4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ                              Code     :
      LUCKNOW
      GSTIN: 09AABCB5730G1ZV                     State Code: UP (09)
                   Report Ref No                           AK/BAGI/AV-8353/09-20/F/02875
                   Vehicle No.                        :     UP20AV 8353
                   Insured Name                    :    LEKHRAJ SINGH
                   Date Of Accident          :            08/09/2020
                   Policy/cover note no           :    OG-21-9906-1843-00010770
                   Claim No                           :    OC-21-1301-1843-00000244

    S No                                             Particulars                                                        HSN/SAC                                     Amount Z
      1     Final                                                                                                           997162                                             1,500.00
                      Professional Fee :             Assessed Amount  -100.00                                                          500.00
                      Photos/CD Expenses :                                                                                                          0.00
                       0 Photographs , Charged for 0 @ Rs. 10.00
                      Conveyance Expenses :                                                                                                   1,000.00
                       BIJNOR TO DHAMPUR
      2                  DA Half Day                                                                                        997162                                                175.00
                                                                                                                                                    Sub Total : 2                1,675.00
                                                                                                                                                C GST @ 9.00 %                   150.75
                                                                                                                                                S GST @ 9.00 %                    150.75
                                                                                                                                                 Grand Total : %                1,976.50
                                                                                                                                                   Round off :                 1,977.00
                                                            In words : Rs. One Thousand Nine Hundred Seventy Six Only
  GSTIN: 09 ADGPA7680K1Z8 State : (09)
  PAN. : ADGPA7680K
  Bank Name: STATE BANK OF INDIA
  A/c No.                : 31013997566
  MICR No              : 264002303                                                             ANUJ KUMAR AGARWAL

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