SAURABH JUNEJA
                                                     SURVEYOR & LOSS ASSESSOR
                                   H.No. 107, Hargobind Enclave, 1st Floor, Vikas Marg Extn. Delhi-110092
License No. : SLA 73349                                                                Mobile No. : 9899 474 475
Valid Up to : 08-04-2023                                                                E-Mail          : srbh.juneja@gmail.com
IIISLA No. : A/N/5997                                                                   Phone(s)                       : 011 - 42058194

                                                                                      Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                        Bill. No : B-12/20/04413
       Block No-4, 7 Th Floor DLF Tower Shivaji Marg New Delhi-110015                                     Date     : 15/12/2020
       New Delhi-110015                                                                                                    Code     :
       GSTIN: 07AABCB5730G1ZZ                     State Code : Delhi (07)
                   Report Ref No                    :     SJ/BAGI/0ER4053/12-20/F/12643
                   Vehicle No.                        :     DL10ER4053
                   Insured Name                    :     CHANDAN KUMAR CHOWDHARY
                   Date Of Accident         :           17/11/2020
                   Policy/cover note no           :     OG-20-1149-1803-00008617
                   Claim No                          :    OC-21-1101-1803-00000701
    S No                                            Particulars                                                       HSN/SAC                                    Amount 
      1     Final                                                                                                          997162                                               650.00
                      Professional Fee :             Assessed Amount  0.00                                                              500.00
                      Photos/CD Expenses :                                                                                                         0.00
                       0 Photographs , Charged for 0 @ Rs. 0.00
                      Conveyance Expenses :                                                                                                    150.00

                                                                                                                                                   Sub Total : %                   650.00
                                                                                                                                               C GST @ 9.00 %                     58.50
                                                                                                                                              S GST @ 9.00 %                      58.50
                ADVANCE RECEIPT                                                                                                  Grand Total : 2                   767.00
                                                                                                                                                  Round off :                    767.00
                                                                    In words : Rs. Seven Hundred Sixty Seven Only
   GSTIN: 07AHGPJ3702K1ZG State : (07)
   PAN. : AHGPJ3702K
   Bank Name: AXIS BANK
   A/c No.                : 913020019916326
   MICR No             : 110211039                                                            SAURABH JUNEJA

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