ANUJ KUMAR AGARWAL
                                                                               Surveyor & Loss Assessor                           Tel. 01342-262305
                                                                         License No. SLA 25892, Exp. 09.11.22                    Mob. 9412215972
                                                                    Fellow Member , Dep. Motor, Marine & Engg.                Email a_bijnor@yahoo.com
                                                                                                                                                Add. H.N. 360, State Bank Colony,
                                                                                                                                                Nai Basti, Bijnor-246701

                                                                                       Survey Fee Bill
To,
      Bajaj Allianz General Insurance Co. Ltd.                                                                          Bill. No : B-08/20/00328
      LUCKNOW                                                                                                                  Date     : 18/08/2020
      4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ                              Code     :
      LUCKNOW
       GSTIN: 09AABCB5730G1ZV                      State Code : UP (09)
                   Report Ref No                           AK/BAGI/BK-1712/08-20/F/02735
                   Vehicle No.                        :     UP20BK 1712
                   Insured Name                    :    SANJAY KUMAR
                   Date Of Accident          :            10/08/2020
                   Policy/cover note no           :     OG-19-4315-1843-00000032
                   Claim No                           :    OC-21-1301-1843-00000183

    S No                                              Particulars                                                         HSN/SAC                                     Amount Z
      1     Final                                                                                                             997162                                             1,200.00
                      Professional Fee :             Assessed Amount  -100.00                                                           500.00
                      Photos/CD Expenses :                                                                                                           0.00
                       0 Photographs , Charged for 0 @ Rs. 10.00
                      Conveyance Expenses :       Visited total 70 Kms. No of visits 1 charged @210.00/ Km                                700.00
                       BIJNOR TO NAJIBABAD
      2                  DA Half Day                                                                                         997162                                                175.00
                                                                                                                                                      Sub Total : 2                1,375.00
                                                                                                                                                  C GST @ 9.00 %                   123.75
                                                                                                                                                 S GST @ 9.00 %                    123.75
                                                                                                                                                  Grand Total : %                1,622.50
                                                                                                                                                     Round off :                 1,623.00
                                                             In words : Rs. One Thousand Six Hundred Twenty Two Only
  GSTIN: 09 ADGPA7680K1Z8 State : (09)
  PAN. : ADGPA7680K
  Bank Name: STATE BANK OF INDIA
  A/c No.                : 31013997566
  MICR No              : 264002303                                                              ANUJ KUMAR AGARWAL

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