Licence No:SLA -31896 Tel.No.:28332089,28986989 Valid Upto :08/04/2022 Mobile No.:-9821215937 DATTA M.KORE AUTOMOBILE SURVEYOR,LOSS ASSESSOR &VALUERS Email: datta.kore08@gnail.com C-107,Beach Classic Apt., Kanti Park,Shimpoli-Gorai Road, Chikuwadi, Borivali (W),Mumbai-92 FINAL SURVEY BILL INSURER : BAJAJ ALLIANZ GENERAL INSURANCECO. LTD. BILL NO:513/20-21 BAGI Andheri Date 21/10/2020 291, Xtrium, 2nd Floor, Next To Holy Family Ghurch, Andheri-Kuria Road, Chakala, Andheri (E), Mumbai-400099. State : Maharashtra - 27 GSTIN No. : 27AABCB5730G1ZX INSURED : RAJAN VINODKUMAR DUBEY POLICY NO. OG-20-1908-1803-00001101 CLAIM NO. OC-21-1901-1803-00000139 VEHICLE NO. :MH 06 BW 2106 SURVEYED AT : NON TIEUP REPAIRER on Dt.: Details Amount Professional Fees SAC Code No.997162 Rs. : 5,000.00 Photograph (@Rs. 10.00 x 0 Copy) Rs. : 0.00 Conveyance () Rs. : 300.00 Total Rs. : 5,300.00 CGST 9% On Rs. 5,000.00 Rs. : 450.00 SGST 9% On Rs. 5,000.00 Rs. : 450.00 Rounded to Nearest Rupees: Rupees : Six Thousand Two Hundred Only Net Total Rs. 6,200.00 GST No. : 27AAPPK5632B1ZS State : Maharashtra Code:27 PAN No. : AAPPK5632B STATE BANK OF INDIA DATTA MKORE a 96 10 S SURVEYOR Advance Receipt a --------------PAGE END----------------------- --------------PAGE END----------------------- Printed On : 14-OCT-2020 Preliminary Survey Report Claim Id : 19095155 Claim No : OC-21-1901-1803-00000139 Customer Name : RAJAN VINODKUMAR DUBEY Registration No : MH06BW2106 Survey Status : P Report Date : SurveyorRegion: BJAZ Address : Surveyor Address : Claimant Name : RAJAN VINODKUMAR DUBEY Phone No : Date of Loss : 28-MAY-20 Mobile No: 9999999999 Claim No : OC-21-1901-1803-00000139 Survey Date : 15-JUN-20 Policy No : OG-20-1908-1803-00001101 Risk Start Date : 30-OCT-19 Risk End 29-OCT-20 Date : Data As Per Evidence Make ASHOK LEYLAND Model 3118 IL Year of Manf 2018 Registration No MH06BW2106 Date Of Reg 13-OCT-2018 Chassis No MB1KACHD9JAXJ6642 Engine No 0000000000JYEZ429217 Color Endt in RC Speedometer Reading 1 Driver Name DL No Place of Issue Endt in DL DL Endt Date DL Exp Date Codification of Accident OG-20-1908-1803-00001101 Description of Loss NA TA M D c * H 17 E H 0 --------------PAGE END----------------------- Preliminary Survey Report Claim No : OC-21-1901-1803-00000139 Survey Date :15-JUN-20 Surveyor Comments Damages are concurrent with statement of accident on claim form. Document Checklist Description Enclosed(Yes/No) Description Enclosed(Yes/No) Registration Cert Repairer Estimate Salvage Photo Satisfaction Voucher Photographs TL Report Driving License TP loss Report Damage Part Details ROREIS M Auth.BAGIC Signature --------------PAGE END----------------------- Claim No : OC-21-1901-1803-00000139 Registration No : MH06BW2106 Printed On : 14-OCT-2020 0 Approval(Annexure-1) Parts Report Claim Id :19095155 QTY Retail Total Net Net Depr Net As- Benefit Price Amount Tax Amt Amt sessed Flag Amt Metal COWL 1 90000 90000 0 90000 9000 81000 CABIN 1 65000 65000 o| 65000 6500 58500 BRAKE PADEL VALVE 1 5787 5787 0 5787 578.7 5208.3 CABIN BKT 4 400 1600 o| 1600 160 1440 HORN 1 400 400 o 400 40 360 STEERING GEAR BOX 1 23000 23000 0 23000 2300 20700 COOLING ASSY 1 25000 25000 o 25000 2500 22500 210787 0 210787 21078.7 189708.3 Plastic ACCELARATORE PADEL 1 1840 1840 0 1840 920 920 STEERING COVER 1 3180 3180 0 3180 1590 1590 COVER 1 350 350 o 350 175 175 SEAT BELT 1 1700 1700 0 1700 850 850 HOOD 1 5500 5500 o 5500 2750 2750 FRONT BUMPER 1 4500 4500 o 4500 2250 1125 IMT23 HEADLAMP ASSEMBLY 2 600 1200 o 1200 600 300 IMT23 FOG LAMP 2 300 600 o 600 300 150 IMT23 CLUSTER MITER COVER 1 1500 1500 0 1500 750 750 CLUSTER MITER 1 7565 7565 o 7565 3782.5 3782.5 26360 o 26360 13967.5 12392.5 Total Parts Amount 238722 0 238722 35046.2 202100.8 Labour Details Claim Id :19095155 Allowed Net Tax WCT Assessed Paint Remarks Amt Depr Removing and Refitting COWL 5500 0 0 5500 0 0 GOVT. S * E BAI --------------PAGE END----------------------- CABIN STRIPING 3500 0 0 3500 0 CABIN 25000 0 0 25000 0 CHASSIS 4500 0 0 4500 0 TANK ASSY 15000 0 0 15000 0 ELWCTRICAL 2500 0 0 2500 0 FRONT AXLE 1500 0 0 1500 0 57500 o 0 57500 0 Denting and Repairs CHASSIS 8500 0 0 8500 0 FRONT AXLE 1800 0 0 1800 0 10300 0 0 10300 0 Painting PAINTING 15000 0 0 6562.5 8437.5 IMT 23 15000 0 0 6562.5 8437.5 Total Labour Amount 82800 0 0 74362.5 8437.5 Total Assessed Amount Parts : 202101 Total Assessed Amount Labour : 74363 Salvage Amount(On Parts) @ 9500 Towing Charges 0 Compulsary Excess 1500 Voluntary Excess :0 Addl/Imposed Excess: :0 Theft Excess : depreciation Amount 44609 Nett Assessed Amount (Parts Labour) 265464 Surveyor Signatare Auth.BAGIC Signature YMB --------------PAGE END-----------------------