Er. Balakrushna Patra,
                                               DME                                            PRAFULLA NIVAS
     SURVEYOR & LOSS ASSESSOR.                                         Near Chandrasini Temple,
     License No: SLA-63776/18-21                                                                 Talpalipara,
     Expiry: 27/04/2021                                                                       Ph: 06652-231649
     GST No. 21AHPPP9901R2ZJ                                                           Cell: 9437150125
          WW0                                                                     !||!l|
    Ref. No. L31405/MVF/2021                                                   Date: 25/03/2021
                                                           BILL
To,
          M/s. -- Bajaj Allianz General Insurance Co. Ltd.,
                    Plot no-9/10,Opposite to Big Bazar,
                     Above South Indian Bank,
                     Satyanagar,Bhubaneswar-751007
                    GST No. 21AABCB5730G1Z9.

A/c     BENUDHAR PARIDA
          AT-BHUBANESWAR

Policy No: OG-21-2403-1803-00000165
Claim No: OC-21-2403-1803-00000320
 SI No.                                                                                Amount
                              Particulars / Description
                                                                                            (in Rs)
 01.       Final survey fees                                              Rs." 5000.00
 02.       Local Conveyance                                            Rs.2250.00
              CD Charges
 03.                                                                                Rs.       00.00


                                                                        Total.     Rs. 5250.00
                                                         Add: 9% CGST     Rs.472.50
                                                          Add: 9% SGST     Rs.472.50
                                                                 Total GST     Rs. 945.00
                                                              Grand Total     Rs. 6195.00

                                                                                                                       Er.
                                                                                                                    *
                                                                                                              5
                                                                                                       Er.Bataknushna Patra,
                                                                                                                 G      9gurveyor.

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