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.      360
                                                                Invoice Date     16.02.2021
Ins Comp.    BAJAJALLIANZ GENERAL INS CO LTD                          GST IN      24AABCB5730G1Z3
                VADODARA                                Nature of Loss : Own damage/repair/spot
Insured     MR. MOHMAD SALIM G SUTHAR      Vehicle No.      GJ07AR2494
Clalim No.  OC-21-2201-1801-00003655                                  Policy No. OG-20-2224-1801-00003478
  Sr. No.               DESCRIPTION                  QTY.         UNIT     RATE            Rs. Ps.
     01      Survey Fees - OD                                  1              Per        1500                      1500.00
      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                       90             Km          7.5                        675.00
                Outstation Conveyance Charges             90              Km          7.5                        675.00
      05      Photograph (CD) Charges                       1             Each          0                             0.00
      06      Other Expense / Toll Taxes                                                                                       0.00
                                                                Sub Total                                                         2850.00
GST IN       24APMPP3544B1Z2                       SGST @           9.00%                                          256.50
SAC CODE   997162                                      CGST @          9.00%                                          256.50
                                                                Grand Total                                                      3363.00
Rupees : Three thousand three hundred sixty three 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
                                                        ?            .
                                                          ANAND
MAHESH PRAJAPATI

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