Licence No. SLA/120614                                                                                           Mobile No.9782773649
Valid upto 10th May 2021                                                                                                            9799730029
                                                                                                                         dipu.dilip2@gmail.com
Surveyor& Loss Assessore of Motor                                                              DILIP KUMAR PRAJAPAT
&Marin Cargo                                                                                                  SURVEYOR& LOSS ASSESSOR
GSTIN-                                                                                                                               154,Rabari Vas,
Reference N DKP/BGIC/09/2020/769                                                                                   Amli Road,Pindwara
                                                                                                                         Dist.Sirohi,Rajasthan-307022
                                                              BILL
Bill No.   769
                                                                                 M/s.:Bajaj Allianz General Insurance Co. Ltd
Date   :    26/09/2020                                                         2nd &3rd floor, 4 Hathroi Fort, Gopalbari
                                                                                         Ajmer Road,Jaipur-302001
                                                                                  GSTI:
Claim No.               OC-21-1401-1802-00000616
Policy No               OG-20-1417-1802-00000566
Vehicle No.            RJ38SC7279
                                                                                   Date of Accident:          15/09/2020
Insured Name         PINTU SO CHELA RAM SAIN                    Date of Survey 19-09-2020
                                                         PARTICULARS                                                               AMOUNT

aProfessional Fee                                                                              Final                                 500.00
                                                                                                         Re-Inspection
b Halting Allowance                                                                                                                      200.00
 Conveyance Local
dFare From         Sirohi To Aburiad
   By Car                                                                                           Final                              1,120.00
    Distance 140KM*8=1120
eSpeed Post=40                                                                                                                         40.00

                                                                                                                                                1,860.00
                                                                                         Add   CGST @9%
PAN No.CZJPK1227R                                                           Add.   SGST @ 9%
                                                                                         Add.   IGST @ 18%
                                                                                                         Total                              1,860.00
BANK -BANK OF BARODA
Address :-Shree Ji Plaza,Near Telephone Exchange,Pindwara-307022
A/c Name Mr. Dilip Kumar Prajapat A/c No.55318100005070
IFS Code BARB0PINSIR Branch Code 307012027
                                                                                                             DILIPKUMAR PRAJAPAT

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