RAKESH KUMAR
                                                   SURVEYOR &LOSSASSESSOR
FLAT NO. 417, C-1, Muskan Appartment, Sector-17, Rohini, New Delhi-89
                                        Mob.#9868110525/8836301125
                                       E-mail: majokarakesh61197@gmail.com
                                       License No. SLA-61197, Valid upto 07/10/2023
                                       Pan No.AHEPK2434R/GST No.07AHEPK2434R2ZZ
Ref:- BAJAJ/FINAL/2020/21/0614                                                                  Dated: 16/03/2021
                                                   HSN/SAC CODE:997162
Bajaj Allianz General Insurance Company Limited.
Block No.4, 7th Floor, DLF Tower-15, Shivaji Marg, 011-66278225, New Delhi-110001.
GST Number:07AABCB5730GIZZ
VEHICLE NO.                :       UP 17N 5388
INSURED NAME           :       MR. SHIVAM PARASAR
CLAIM NO.                     :       0C-21-1101-1802-00003195
POLICY No.                     :       OG-21-1901-1802-00082765
ASSESSED LOSS             :       Rs. 9000/-


Professional
Professional Fee                                                                                                                                550.00
Visit to workshop                           Rohini to Baghpat, UP 114*4                                                   456.00
RE-Inspection Charges                                                                                                                         0.00
Under repair                                                                                                                                         0.00
Spot & In-person verification          Rohini to Baghpat, UP 124*4                                                   496.00
TOTAL                                                                                                                                          1502.00
CGST@9%:                                                                                                                                         135.18
SGST@9%                                                                                                                                           135.18
GROUND TOTAL                                                                                                                        1772.36

                                                                                                                                    e.

Thanks & Regards
Rakesh Kumar

    x
   E(stAeru7g
(Authorized Signatory)

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