B.K.Gupta       Surveyor, Loss Assessor & Valuer
Lic.no. 26815/Exp. 28.01.2023
                                          2-Ka-15,Dadabari, Kota-9
Phone :94141-88998                                          E-mail : bkgsurvey@yahoo.co.in
GSTI No.: 08ABYPG9645A1ZA                                            PAN No. : ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no.:  Baj-120                                                                         Date : 04.12.2020
issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c: Mr.Ram Dayal Ji
Reg.: Final Survey of Vehicle no. RJ-33-CA-3368
Policy/C.note no./Period : OG-21-1401-1801-00007967 /01.11.2020 to 31.10.2021
Claim no.: OC-21-1401-1801-00003604                        S/Allott. Date : 26.11.2020
Date of Loss : 25.11.2020                                            S/Rep.no.: Bajaj/MT/20-21/120
                                                                                                    Rs.         500.00
2.Photographs CD                                                                         Rs.            0.00
3.Locai Conveyence                                                                     Rs.         350.00
4.Out station Expanses:                                                                 Rs.

5.Haulting Allownce:                                                                     Rs.
6.Other Expanses                                                                          Rs.
                                                                                                                  850.00
                                                                      CGST    9.00%        Rs.          76.50
                                                                      SGST    9.00%         Rs.          76.50
                                                                              Total              Rs.       1003.00
(Rupees One Thousand Three Only)

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