SAURABH JUNEJA
                                                    SURVEYOR & LOSS ASSESSOR
                                   H.No. 107, Hargobind Enclave, 1st Floor, Vikas Marg Extn. Delhi-110092
License No. : SLA 73349                                                                Mobile No. : 9899 474 475
Valid Up to : 08-04-2023                                                                E-Mail          : srbh.juneja@gmail.com
IIISLA No. : A/N/5997                                                                   Phone(s)                       : 011 - 42058194

                                                                                     Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                        Bill. No : B-11/20/04227
       Block No-4, 7 Th Floor DLF Tower Shivaji Marg New Delhi-110015                                     Date     : 12/11/2020
       New Delhi-110015                                                                                                    Code     :
       GSTIN: 07AABCB5730G1ZZ                     State Code : Delhi (07)
                   Report Ref No                    :     SJ/BAGI/6CT0221/11-20/F/12524
                   Vehicle No.                       :    UP16CT0221
                   Insured Name                   :     LAL BABU SAHU
                   Date Of Accident         :           28/10/2020
                   Policy/cover note no           :    OG-20-1103-1803-00001949
                   Claim No                          :    OC-21-1103-1803-00000786
    S No                                            Particulars                                                       HSN/SAC                                    Amount 
      1     Final                                                                                                         997162                                              900.00
                      Professional Fee :             Assessed Amount & 11,000.00                                                      750.00
                      Photos/CD Expenses :                                                                                                        0.00
                       0 Photographs , Charged for 0 @ Rs. 0.00
                      Conveyance Expenses :                                                                                                   150.00

                                                                                                                                                  Sub Total : %                   900.00
                                                                                                                                              C GST @ 9.00 %                     81.00
                                                                                                                                             S GST @ 9.00 %                     81.00
                ADVANCE RECEIPT                                                                                                  Grand Total : 2                1,062.00
                                                                                                                                                 Round off :                 1,062.00
                                                                      In words : Rs. One Thousand Sixty Two Only
   GSTIN: 07AHGPJ3702K1ZG State : (07)
   PAN. : AHGPJ3702K
   Bank Name: AXIS BANK
  A/c No.               : 913020019916326
   MICR No             : 110211039                                                            SAURABH JUNEJA

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