Vivek M. Desai
                                               Surveyor & Loss Assessor.(Motor)
Licence No.: S.L..A. 73760                                                                            Address:          29, Anand Nager Society, Morabhagal,
Valid upto: 03rd Oct.2021.                                                                                                            Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                              (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                              SURVEYFEEBILL

                                                                                    TAX INVOICE
To,                                                             BILL NO.                  2154-12-2020-21
Bajaj Allianz General Insurance Co. Ltd. (Regional OfficDATE                     01-12-2020
4th Floor, Atlartis Heritage,
Opp-Swagat Petrol Pump,                                     Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
Sarabhai Road, Vadodara -390007                        Office Code
           GSTIN No. 24AABCB5730G1Z3         Claim No                  OC-21-2203-1803-00000249
REPORT NO              VD/BAGIC/12/2020/2154                                                                DATE OF LOSS          10-Nov-2020
INSURED                  HARJIBHAI PANCHABHAI DIHORA                                                  DATE OF SURVEY       12-Nov-2020
POLICY NO.              OG-20-2202-1803-00024809
VEHICLE REGN. NO.       GJ05 CT 2896                   MAKE                     Auto rikshwa               PLACE OF SUPPLY           GUJARAT
ESTIMATED LOSS       Rs.45,000                          ASSESSED LOSS                                        STATE OF SUPPLY           GUJARAT
DESCRIPTION                                                          NO./KM                   RATE                 AMOUNT
01.PROFESSIONALFEES                                                                                                      Rs.        1,000.00
SPOT SURVEY
FINAL SURVEY                                                                                                      Rs.        1,000.00
RE-INSPECTION
02.EXPENSES                                                                                                                           Rs.          750.00
PHOTOGRAPH                                                                          Rs.                        Rs.
CONVEYANCE CHARGES                                           3             Rs.             250.00  Rs.           750.00
HALTING ALLOWANCE                                                                                           Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                 Rs.
OUTSTATION TRAVELLING EXPENSES                                                                     Rs.
                  FROM
                       TO                                                                   Rs.                        Rs.
 03.TOTAL FEES:                                                                                                                        Rs.        1,750.00
                                                                            CGST                     @                        9%            Rs.          157.50
  HSN/SAC CODE
                                TAXES (00440169)            SGST                     @                        9%            Rs.          157.50
        997162                                                        IGST                      @                                         Rs.
TOTAL:                                                                                                                                              Rs.       2,065.00
 TOTAL AMOUNT WITH TAX:                                                                                                          Rs. 2,065.00
                                                                                                                  Rupeess Two Thousand Sixty Five Only
   HSN/SAC CODE                997162
                       CENTRAL TAX                                          STATE TAX                                   INTERSTATE TAX
          RATE                      AMOUNT                      RATE                 AMOUNT                RATE                 AMOUNT
            9%                          157.50                         9%                     157.50
   TAXABLE VALUE   Rs.                    1,750.00
     TOTAL TAX RS.     Rs.                      315.00

              GSTIN No.: 24AJAPD3623K1ZN                                      M  DESA
                                                                                        EK
                PAN No.: AJAPD3623K
 E &OE PRE RECEIPTED                                                                 SURA                          V.m.9esai
                                                                                   S    8   N      g

                                                                                                                              Vivek m desai
                                                                                                                           Surveyor & Loss Assessor.
 * Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No: 73760, Valid Upto: 03/10/2021.

---PAGE END---