Er. KANHAIYA CHAUHAN
             Govt.Approved
SURVEYOR & LOSS ASSESSOR
INVESTIGATER,VALUER & CLAIM ADVISER
SPECIALIST IN MOTOR CLAIM'S
GST NO 09AENPC3685E1ZD
PAN NO.AENPC3685E
LICENCE NO.SLA-120150

BILL NO. MOTOR/FINAL/BAJAJ/368/20-21                                                  DATE 11.01.2021

     INSURERS                                  BAJAJ ALLIANZ GENERAL INSURANCE CO. Ltd.
     ADDRESS                                   THE SILVER LINE,11/9,CIVIL LINES KANPUR
     INSURED                                    MR Radhakrishna verma        MODEL      Maruti Swift Dezire
     POLICY/COVER NOTE       :     OG-20-9906-1801-00157186   VEHICLE NO. UP32 EQ 9922
     CLAIM NO.                                   OC-21-1302-1801-00002971
     DATE OF ACCIDENT            :     27.12.2020                    DATE OF SURVEY 30.12.2020

                                                                                               Amount (Rs.) Pa.
 1. Survey Fee                                                                               750        00

                                           covered 46 KM FROM panki to KTL
2. Conveyance                   ramadevi kanpur & BACK@Rs           350
                                                              7.5/km                                            00
 3. C D charges                                                                                            00
4 Re Inspection                                                                             0
     C GST                                                    9%                             99
6 SGST                                                    9%                             99
 4. Toll Tax                                                                                     0
                                                                                   G Total      1298        00

Rupees one Thousand Two Hundred Ninty Eight only .

      Cheque No :                                                                      Bank A/c No.20006890666
                                                                                               IFS code SBIN0000242
     Date:                                                                                Stae Bank of India

                                                                                                                                              oen
     E.&O.E.                                                                                           Kanhaiya Chauhan SLA-120150

                                                                                                                                               SLA-120150

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