MAHESHPRAIAPATI                               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.      233
                                                                    invoice Date     02.12.2020
Ins Comp.   BAJAJALLIANZ GENERAL INS CO LTD                           GSTIN      24AABCB5730G1Z3
                  VADODARA                                 Nature of Loss : Own damage/repair/spot
Insured     MR. YAGNESHKUMAR D TRIVEDI       Vehicle No.      GJ35D2905
Clalim No.  OC-21-2201-1802-00000641                                    Policy No.OG-21-3065-1802-00000412
   Sr.No.                DESCRIPTION                   QTY.          UNIT      RATE             Rs.Ps.
      01      Survey Fees -OD                                    1               Per          350                         350.00
      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                         1              Each           0                               0.00
                 Outstation Conveyance Charges             154              Km           7.5                        1155.00
      05      Photograph(CD)Charges                        1              Each           0                              0.00
      06      Other Expense/Toll Taxes                                                                                            0.00
                                                                    Sub Total                                                            1505.00
GSTIN        24APMPP3544B1Z2                        SGST @           9.00%                                            135.45
SACCODE   997162                                        CGST@           9.00%                                            135.45
                                                                    Grand Total                                                         1775.90
Rupees: One thousand seven hundred seventy six only.

E.and O.E.                                                                            Bank Details:
Subject to Anand Jurisdiction                                                 ICICI Bank - Anand (Gamdivad Branch-0256)
                                                                             PRA
Pan No.:APMPP3544B                                                          Account No.:000301531217
SACCODE9997162                                           SURVEYOR        IFSC Code :ICIC0000256
                                                                        SLA-35079        Account Type : Savings
                                                                                    0

MAHESH PRAJAPATI

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