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-07/20/00256 LUCKNOW Date : 24/07/2020 4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ Code : LUCKNOW GSTIN: 09AABCB5730G1ZV State Code: UP (09) Report Ref No AK/BAGI/BN-8676/07-20/F/02658 Vehicle No. : UP20BN 8676 Insured Name : MUKESH DEVI Date Of Accident : 31/05/2020 Policy/cover note no : OG-20-1307-1826-00000896 Claim No : OC-21-1302-1826-00000068 S No Particulars HSN/SAC Amount Z 1 Final 997162 1,060.00 Professional Fee : Assessed Amount -100.00 500.00 Photos/CD Expenses : 0.00 0 Photographs , Charged for 0 @ Rs. 10.00 Conveyance Expenses : 560.00 2 ReInspection 997162 0.00 Professional Fee : 0.00 Photos/CD Expenses : 0.00 0 Photographs , Charged for 0 @ Rs. 10.00 Conveyance Expenses : 0.00 3 D.A. One day 997162 200.00 Sub Total : % 1,260.00 C GST @ 9.00 % 113.40 S GST @ 9.00 % 113.40 Grand Total : % 1,486.80 Round off : 1,487.00 In words : Rs. One Thousand Four Hundred Eighty Seven Only GSTIN: 09 ADGPA7680K1Z8 State : (09) PAN. : ADGPA7680K Bank Name: STATE BANK OF INDIA A/c No. : 31013997566 MICR No : 264002303 ANUJ KUMAR AGARWAL ---PAGE END---