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/2020/21/0336                                                                    Dated: 26/11/2020
                                                    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 17L 6357
 INSURED NAME           :        HARENDRA KUMAR
 CLAIM NO.                     :       0C-21-1103-1802-00002412
 POLICY No.                      :        OG-21-1119-1802-00000006
 ASSESSED LOSS              :       Rs. 3500/-


 Professional
 Professional Fee                                                                                                                                  450.00
 Visit to workshop                                 Rohini To Baraut, UP 132*4                                                        528.00
RE-Inspection Charges                                           :                                                                              0.00
Under repair                                                                                                                                           0.00
Spot inspection Fee                                                                                                                                0.00
TOTAL                                                                                                                                             978.00
CGST@9%:                                                                                                                                             88.02
SGST@9%                                                                                                                                              88.02
GROUND TOTAL                                                                                                                          1154.04


Thanks & Regards
Rakesh Kumar
SurNeyOMOYSTossAssessors.
(AuthoNZe& Sighatory)

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