MAHESH PRAIAPATI                                Contact No.7574844245
SURVEYOR&LOSS ASSESSOR&VALUER                            22, Vaikunth Park Society, Nr. Ashruti Tenament,
Promoted By IRDA,Govt.of India                                                                          Jitodia Road, Anand -388001
SLA NO.85079 Valid up to 09.10.2022                        Email : mahesh.bagic@gmail.com

                                                    Bill Cum Advance Receipt
                                                                      Invoice No.      299
                                                                      Invoice Date     30.12.2020
Ins Comp.   BAJAJALLIANZ GENERALINS CO LTD                            GSTIN      24AABCB5730G1Z3
                  VADODARA                                  Nature of Loss : Own damage/repair/spot
Insured     MR. JIGARKUMAR N PATEL              Vehicle No.       GJ23Y7388
Clalim No.  OC-21-2201-1803-00000228                                     Policy No. OG-21-2224-1803-00000389
   Sr.No.                DESCRIPTION                    QTY.          UNIT      RATE             Rs.Ps.
      01       Survey Fees-OD                                     1                Per         2500                       2500.00
      01      Survey Fees -Spot                                   1               Per            0                               0.00
      02       Re Inspection Fees                                  1                Per            0                               0.00
      03       Daily Allowance                                       1               Each           0                               0.00
      04      Local Conveyance Charges                       1               Each         300                          300.00
                  Re inspection visits/Spot                          1                Km            0                               0.00
                  Outstation Conveyance Charges               1                Km            0                               0.00
      05       Photograph (CD) Charges                         1              Each           0                               0.00
      06       Other Expense/Toll Taxes                                                                                              0.00
                                                                     Sub Total                                                              2800.00
GSTIN        24APMPP3544B1Z2                         SGST @            9.00%                                             252.00
SACCODE   997162                                         CGST @            9.00%                                             252.00
                                                                      Grand Total                                                          3304.00
Rupees: Three thousand three hundred four only.

E.and O.E.                                                      PRA                Bank Details:
Subject to Anand Jurisdiction                                                   ICICI Bank - Anand (Gamdivad Branch-0256)
                                                              SH
                                                                  S
Pan No.:APMPP3544B                               SUP    YOR               Account No. :000301531217
SACCODE   997162                                     SLA-35079                IFSC Code ICIC0000256
                                                               0
                                                                                             Account Type : Savings


MAHESH PRAJAPATI

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