HIRAL S. PATEL
                                      SURVEYOR & LOSS ASSESSOR, VALUER
     Lic No        : 72693 / 19-22                                                                      417, Navrang Complex,
      Exp. Date    : 09-03-2022                                                                         Nr. Uttsav Hotel,
      Mobile No.   : 9879063617                                                                        Raopura,
     E-mail        : patelhiral66@yahoo.com                                                         Vadodara - 390 001.
OUR REF.                 : BAJAJ/HSP/20/718                                                         04 December 2020
OUR BILL NO.           : BAJAJ/HSP/20/718
                                                       BILL / ADV.RECEIPT.

To,
The Claim Manager,
Bajaj Allianz General Insurance Co. Ltd,
Branch Office, Baroda.

                                           Reg.:                  Final Survey of M/V No. GJ-16-AP-9968
                                                               A/c. Mr. Rajendra Desai
                                                                      Vadodara
                                                   Policy No.                    : OG-20-2225-1801-00007348
                                                    Claim No.                    : OC-21-2201-1801-00003572
                                                   Period                         : 24.02.2020 to 23.02.2021

SR NO.                                               PARTICULARS                                                   AMOUNT

   01.   PROFESSIONAL SURVEY CHARGES. : ( FINAL )                                               Rs.  1000.00

   02.    CONVEYANCE EXPENSES : ( FINAL TWO VISIT + RI = THREE VISIT                   Rs.  0450.00

   03.    PHOTOGRAPH EXPENSES: Photo CD (Digital Photo)                                    Rs.   0040.00
   04.    HAULTING ALLOWANCE. :                                                                          Rs.   0000.00
                       SUB TOTAL.                                                                                    Rs.   1490.00
   05.   SGST 09%                                                                                                 Rs.    134.00
             CGST 09%                                                                                                 Rs.     134.00
       Rs. One Thousand Seven Hundred Fifty Eight Only.                                          Rs.    1758.00
                                                                                S  P
OUR PAN NO.           : AKUPP7626D                                A
OUR GST NO.          : 24AKUPP7626D1ZT             SURVEYOR
                                                                      H&LOSSASSESSORS
INSURER GST NO.    : 24AABCB5730G1Z3
                                                                              72893-19/22
                                                                                           @
                                                                                                              HIRAL PATEL
                                                                                                 SURVEYOR & LOSS ASSESSOR

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