MAHESH PRAJAPATI                              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.      386
                                                                Invoice Date     05.03.2021
Ins Comp.    BAJAJALLIANZ GENERAL INS CO LTD                          GST IN      24AABCB5730G1Z3
                VADODARA                               Nature of Loss : Own damage/repair/spot
Insured     MR. CAPITAL TRANSPORT               Vehicle No.      GJ07YZ6121
Clalim No.  OC-21-2201-1803-00000274                                  Policy No. OG-21-2203-1803-00002316
  Sr. No.               DESCRIPTION                  QTY.         UNIT     RATE            Rs. Ps.
     01      Survey Fees - OD                                  1              Per        5000                     5000.00
      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          0                             0.00
                Re Inspection visits/Spot                      135             Km         7.5                      1012.50
                Outstation Conveyance Charges            135             Km          7.5                       1012.50
      05      Photograph (CD) Charges                       1             Each          0                             0.00
      06      Other Expense / Toll Taxes                                                                                      0.00
                                                               Sub Total                                                        7025.00
GST IN       24APMPP3544B1Z2                       SGST @           9.00%                                         632.25
SAC CODE   997162                                      CGST @          9.00%                                         632.25
                                                               Grand Total                                                     8289.50
Rupees :Eight thousand two hundred ninty only.

E. and O.E.                                                                       Bank Details :
Subject to Anand Jurisdiction                                              ICICI Bank - Anand (Gamdivad Branch-0256)
Pan No. : APMPP3544B                               PRAJ                Account No. : 000301531217
SAC CODE  997162                                                            IFSC Code : ICIC0000256
                                                                      P            Account Type : Savings
                                                         SURVEYORA
                                                          SLA-85079 I
                                                        ?
                                                         ANAND
MAHESH PRAJAPATI

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