Lic.no26815/Exp.28.01.2023        B.K.Gupta       Surveyor. Loss Assessor & Valuer
                                          2-Ka-15,Dadabari,Kota-9
Phone :94141-88998                                         E-mail:bkgsurvey@yahoo.co.in
GSTI No.: 08ABYPG9645A1ZA                                            PAN No.: ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no.:Baj-05                                                                          Date : 20.05.2020
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c : Mr. Ajitesh Kumar Meena
Reg.: Final Survey of Vehicle no. RJ-14-YC-5148
Policy/C.note no./Period : OG-20-1401-1801-00013341 /26.12.2019 to 25.12.2020
Claim no.: OC-20-1401-1801-00007896                        S/Allott. Date : 02.02.2020
Date of Loss :31.01.2020                                            S/Rep.no.: Bajaj/MT/20-21/05
                                                                                                   Rs.       1500.00
2.Photographs CD                                                                        Rs.          50.00
3.Local Conveyence [Final+Reins.]                                                Rs.         700.00
4. Out station Expanses :                                                                 Rs.

5. Haulting Allownce:                                                                     Rs.
6.Other Expanses                                                                         Rs.
                                                                                                               2250.00
                                                                     CGST    9.00%        Rs.        202.50
                                                                      SGST    9.00%         Rs.        202.50
                                                                             Total              Rs.       2655.00
(Rupees Two Thousand Six Hundred Fifty five Only)

---PAGE END---