RAKESH KUMAR
                                                    SURVEYOR&LOSS ASSESSOR
 FLAT NO. 417, C-1, Muskan Appartment, Sector-17, Rohini, New Delhi-89
                                         Mob.#9868110525/8836301125
                                         E-mail: majokarakesh61197@gmail.com
                                         License No. SLA-61197, Valid upto 07/10/2023
                                         Pan No.AHEPK2434R/GST No.07AHEPK2434R2ZZ
 Ref:- BAJAJ/FINAL/2020/21/0342                                                                    Dated: 28/11/2020
                                                    HSN/SAC CODE:997162
 Bajaj Allianz General Insurance Company Limited.
 Block No.4, 7th Floor, DLF Tower-15, Shivaji Marg, 011-66278225, New Delhi-110001.
 GST Number:07AABCB5730GIZZ
 VEHICLE NO.                 :       UP 17P 2811
 INSURED NAME           :       SHAILESH KUMAR TIWARI
 CLAIM NO.                     :        OC-21-1103-1802-00002470
 PolICY No.                               OG-21-4321-1802-00000395
 ASSESSED LOSS                       Rs. 6400/-


 Professional                                                                                                                8
Professional Fee                                                                                                                                  550.00
 Visit to workshop                                Rohini To Bagpath, UP 115*4                                                       460.00
RE-Inspection Charges                                                                                                                            0.00
Under repair                                                                                                                                           0.00
Spot inspection Fee                                                                                                                                 0.00
TOTAL                                                                                                                                            1010.00
CGST@9%:                                                                                                                                             90.90
SGST@9%                                                                                                                                                90.9
GROUND TOTAL                                                                                                                           1191.80

                             B

Thanks & Regards
Rakesh Kumar
SurveyorsLossAssessors.
                 Totsh
(AuthorizedSignatory)

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