HIRAL S. PATEL
                                     SURVEYOR & LOSS ASSESSOR, VALUER
     Lic No        : 72693 / 19-22                                                                    417, Navrang Complex,
     Exp. Date   : 09-03-2022                                                                       Nr. Uttsav Hotel,
     Mobile No.   : 9879063617                                                                      Raopura,
     E-mail        : patelhiral66@yahoo.com                                                        Vadodara - 390 001.
OUR REF.                 : BAJAJ/HSP/20/1024                                                        18 February 2021
OUR BILL NO.           : BAJAJ/HSP/20/1024
                                                      BILL / ADV.RECEIPT.

To,
The Claim Manager,
Bajaj Allianz General Insurance Co. Ltd,
Branch Office, Baroda

                                         Reg.:                  Final Survey of M/V No. GJ-06-EH-9300
                                                             A/c. Mr MANISHBHAI B PATEL
                                                                    Vadodara
                                                  Policy No.                   : OG-21-2201-1801-00001107
                                                  Claim No.                    : OC-21-2201-1801-00005138
                                                  Period                        : 05.05.2020 TO 04.05.2021
SR NO.                                             PARTICULARS                                                 AMOUNT
   01.   PROFESSIONAL SURVEY CHARGES. : ( FINAL )                                              Rs.  1000.00

   02.   CONVEYANCE EXPENSES : (FINAL TWO VISIT + RI = THREE VISIT)                  Rs.   0450.00

   03.   PHOTOGRAPH EXPENSES: Photo CD (Digital Photo)                                   Rs.   0040.00
   04.    HAULTING ALLOWANCE. :                                                                         Rs.   0000.00
                      SUB TOTAL.                                                                                  Rs.   1490.00
   05.  SGST 09%                                                                                              Rs.    134.00
            CGST 09%                                                                                              Rs.    134.00
       Rs. One Thousand Seven Hundred Fifty Eight Only.                                                  1758.00
                                                                             S.P
OUR PAN NO.           : AKUPP7626D
OUR GST NO.          : 24AKUPP7626D1ZT             SURVEYOR   3
                                                                    H &LOSS ASSESSORS
INSURER GST NO. : 24AABCB5730G1Z3
                                                                            72893-19122
                                                                                        @
                                                                                                          HIRAL PATEL
                                                                                              SURVEYOR & LOSS ASSESSOR

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