Lic.no.: 26815/Exp. 28.01.2023         B.K. Gupta       Surveyor, Loss Assessor & Valuer
                                           2-Ka-15,Dadabari, Kota-9
Phone :94141-88998                                           E-mail : bkgsurvey@yahoo.co.in
GSTI No.: 08ABYPG9645A1ZA                                             PAN No.: ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no.Baj-160                                                                           Date : 03.02.2021
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c : Mr.Sahil Kalra
Reg.: Final Survey of Vehicle no. MH-12-MF-9749
Policy/C.note no./Period : OG-21-1402-1801-00000143 /11.05.2020 to 10.05.2021
Claim no. : OC-21-1401-1801-00004428                         S/Allott. Date : 08.01.2021
Date of Loss : 06.01.2021                                              S/Rep.no.: Bajaj/MT/20-21/160
                                                                                                      Rs.       1500.00
2.Photographs CD                                                                          Rs.            0.00
3.Local Conveyence [Final +K.Open +Reins.]                                   Rs.       1050.00
4. Out station Expanses :                                                                  Rs.

5.Haulting Allownce:                                                                       Rs.
6.Other Expanses                                                                           Rs.
                                                                                                                  2550.00
                                                                       CGST    9.00%         Rs.         229.50
                                                                       SGST    9.00%         Rs.         229.50
                                                                               Total              Rs.       3009.00
(Rupees Three Thousand Nine Only)

---PAGE END---