Pankaj Garg                                                          18, Surya Sushant Vihar, Goyal Vihar Road,
Survey & Loss Assessor                                                      Khajrana Ganesh Mandir, Indore 452016
(Motor & Engineering / Fellow )                                                 Email : pankajopgarg@yahoo.com
IRDA/IND/SLA-56941/22/10/2022                                          Mobile No : 98270 34881, 97549 34882
                                                                                            Tax Invoice
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                           Bill. No : 05507
        4th Floor, Commerce House, 7 Race Course Road, Indore M.P.                                             Date:         27/02/2021
                                                                                                                                           Code    : Nil
       GSTIN:223AABCB5730G1Z5                     State Code  : M.P. (23)
                    Report Ref No              :            BA/4389/20-21
                    Vehicle No.                                MH43BG4389
                    Insured Name              :            VINOD KUMAR
                    Date of accident           :           18/12/2020
                    Policy/cover note no     :            OG2119011803-2556
                    Claim No                     :           OC2123021803-121

     S No                                               Particulars                                                         HSN/SAC                                      Amount F
       1     Final                                                                                                              997162                                              1,900.00
                       Professional Fee :             Assessed Amount F 55,000.00                                                      1,500.00
                       Photos/CD Expenses :                                                                                                            50.00
                        CD with digital photographs
                       Conveyance Expenses :                                                                                                        350.00

       2     Relnspection                                                                                                  997162                                              1,200.00
                       Professional Fee :                                                                                                                850.00
                       Photos/CD Expenses :                                                                                                              0.00
                        0 Photographs , Charged for 0 @ Rs. 15.00
                       Conveyance Expenses :                                                                                                        350.00

                                                                                                                                                         Sub Total : F                 3,100.00
                                                                                                                                                     C GST @ 9.00 %                    279.00
                                                                                                                                                     S GST @ 9.00 %                    279.00
                 ADVANCE RECEIPT                                                                                                       Grand Total : F                 3,658.00
                                                                                                                                                         Round off : F                 3,658.00
                                                               In words : Rs. Three Thousand Six Hundred Fifty Eight Only
   GSTIN: 23ACHPG3536G1ZZ State : (23)
   PAN. : ACHPG3536G
   Bank Name: Central Bank Of India
   A/c No.                : 1580809589
   MICR No       : 452016006                                                                                              (PANKAJ GARG)
   IFS Code       : CBIN0281097

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