Er.KANHAIYA CHAUHAN Govt.Approved SURVEYOR&LOSS ASSESSOR INVESTIGATER,VALUER& CLAIM ADVISER SPECIALIST IN MOTOR CLAIM'S GST NO 09AENPC3685E1ZD PAN NO.AENPC3685E LICENCE NO.SLA-120150 BILL NO. MOTOR/FINAL/BAJAJ/445/20-21 DATE 20.02.2021 INSURERS BAJAJ ALLIANZ GENERAL INSURANCE CO. Ltd. ADDRESS THE SILVER LINE,11/9,CIVIL LINES KANPUR INSURED Mr Sudheer Kumar MODEL Hero Passion Pro POLICY /COVER NOTE OG-21-1901-1802-00066128 VEHICLE NO. UP 79 L 0157 CLAIM NO. OC-21-1302-1802-00001955 DATE OF ACCIDENT 13.11.2021 DATE OF SURVEY17.01.2021 Amount (Rs.)|Pa. 1. Survey Fee 500 00 covered 220 km From Panki to Northern 2. Conveyance 1650 Mobikes Auraiya& back @ 7.5/km 00 3. C D charges 00 4 Re-Inspection 5 S GST 9% on the Gross Fee Amount 193.5 6 CGST 9%on the Gross Fee Amount 193.5 7 Toll Tax G Total[ 2537 00 Rupee Two Thousent Five Handred Tharty seven only. Cheque No : Bank A/c No.20006890666 IFS code SBIN0000242 Date: Stae Bank of India E.&O.E. Kanhaiya Chauhan SLA-120150 * SLA-120150 ---PAGE END---