PRAVIN M. MUSALE
                                                     Motor Surveyor, Loss Assessor and Valuer
                                                    License No. : SLA - 73064 Exp.Dt. 08-02-2022
                                                                604 / Rilletta E / Casa Rio Gold,
                                             Kalyan-Shil Road, Dombivali East, Maharashtra - 421204
                                                                        Mobile. : 9821681100

                                                                  Final Survey Fees Bill

BILL NO               : BA/F/019                                                                                       Date : 28/12/2020

INSURERS           : BAJAJ ALLIANZ GENERAL INSURANCE CO. LT Div./Branch : Mumbai
POLICY NO.          :
CLAIM NO.            : OC-21-1901-1801-00010283
INSURED              : Mr RAJESH MADHUKAR GAIKWAD
VEHICLE NO.        : MH 04 GJ 8527
SURVEYED AT  : BABLU AUTO GARAGE,ULHASNAGAR On Dt. : 28/12/2020

Professional Fees                                                                                             Rs.           1,000.00
Photograph (at Rs. 10.00 x 0 Copy)                                                              Rs.                    0.00
Traveling Expenses 60 km. Rs. 7.50                                                                Rs.                450.00
Holting Allowance                                                                                             Rs.
Out city Allowance                                                                                            Rs.
Total                                                                                                                Rs.             1,450.00
18.00% GST Rs. 1,450.00                                                                                Rs.             261.00
Net Total                  Rounded to Nearest Rupees :                                           Rs. :         1,711.00
RupeeS :ONE THOUSAND SEVEN HUNDRED ELEVEN ONLY

Service Tax No.       : GSTIN NO. - 27ALPPM7590M1Z3
PAN NO. :                     ALPPM7590M
                                                                                                                     PRAVIN M. MUSALE
Advance Receipt

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