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 : 05246
        4th Floor, Commerce House, 7 Race Course Road, Indore M.P.                                            Date:         29/06/2020
                                                                                                                                          Code: Nil
       GSTIN:223AABCB5730G1Z5                     State Code: M.P.(23)
                    Report Ref No                           BA/3434/20-21
                    Vehicle No.                                UP70HT3434
                    Insured Name              :            SALMAN KHAN
                    Date of accident           :           08/03/2020
                    Policy/cover note no     :            OG2022021803-1800
                    Claim No                     :           OC2023021803-340

     S No                                               Particulars                                                         HSN/SAC                                      Amount F
       1     Final                                                                                                              997162                                              2,900.00
                       Professional Fee :             Assessed Amount F 101,000.00                                                    2,500.00
                       Photos/CD Expenses :                                                                                                           50.00
                        CD with digital photographs
                       Conveyance Expenses :                                                                                                        350.00

       2     Relnspection                                                                                                 997162                                                 700.00
                       Professional Fee :                                                                                                                350.00
                       Photos/CD Expenses :                                                                                                             0.00
                        0 Photographs , Charged for 0 @ Rs. 15.00
                       Conveyance Expenses :                                                                                                        350.00

                                                                                                                                                        Sub Total : F                 3,600.00
                                                                                                                                                    C GST @ 9.00 %                   324.00
                                                                                                                                                     S GST @ 9.00 %                    324.00
                 ADVANCE RECEIPT                                                                                                       Grand Total : F                 4,248.00
                                                                                                                                                        Round off : F                 4,248.00
                                                               In words : Rs. Four Thousand Two Hundred Forty 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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