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 Mimbership No:L/W/06452 (M)9879666447 & E-Mail: desaivivek29@gmail.com SURVEYFEEBILL TAX INVOICE To, BILL NO. 2369-03-2020-21 Bajaj Allianz General Insurance Co.Ltd. (Regional OfficDATE 24-03-2021 4th Floor, Atlantis 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-21-2203-1803-00000379 REPORT NO VD/BAGIC/03/2021/2369 DATE OF LOSS 14-Feb-2021 INSURED LATIFBHAI VHORA DATE OF SURVEY 25-Feb-2021 POLICY NO. OG-21-2201-1803-00002564 VEHICLE REGN. NO. GJ06 AY 6870 MAKE Bajaj Auto PLACE OF SUPPLY GUJARAT ESTIMATED LOSS Rs.45,000 ASSESSED LOSS STATE OF SUPPLY GUJARAT DESCRIPTION NO./KM RATE AMOUNT 01.PROFESSIONALFEES: Rs. 750.00 SPOT SURVEY FINAL SURVEY Rs. 750.00 RE-INSPECTION 02.EXPENSES Rs. 450.00 PHOTOGRAPH Rs. Rs. CONVEYANCE CHARGES Rs. 450.00 Rs. 450.00 HALTING ALLOWANCE Rs. OUT OF POCKET EXPENSES (COURIER) Rs. OUTSTATION TRAVELLING EXPENSES Rs. FROM TO Rs. Rs. 03.TOTAL FEES: Rs. 1,200.00 CGST @ 9% Rs. 108.00 HSN/SAC CODE TAXES (00440169) SGST @ 9% Rs. 108.00 997162 IGST @ Rs. TOTAL: Rs. 1,416.00 TOTAL AMOUNT WITH TAX: Rs.1,416.00 Rupeess One Thousand Four Hundred Sixteen Only HSN/SAC CODE 997162 CENTRAL TAX STATE TAX INTERSTATE TAX RATE AMOUNT RATE AMOUNT RATE AMOUNT 9% 108.00 9% 108.00 TAXABLE VALUE Rs. 1,200.00 TOTAL TAX RS. Rs. 216.00 GSTIN No.:24AJAPD3623K1ZN EKM.ODESAI VIV PAN No.: AJAPD3623K SYRAT E&OE PRE RECEIPTED 2 6 0 0 V.M.Desai 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---