Licence No.SLA/120614                                                                                      Mobile No.:9782773649
Valid upto 10th May 2021                                                                                                      9799730029
                                                                                                                    dipu.dilip2@gmail.com
Surveyor & Loss Assessore of Motor                                                           DILIP KUMAR PRAJAPAT
&Marin Cargo                                                                                             SURVEYOR & LOSS ASSESSOR
GSTIN-                                                                                                                        154,Rabari Vas,
Reference N DKP/BGIC/11/2020/840                                                                               Amli Road,Pindwara
                                                                                                                  Dist.Sirohi,Rajasthan-307022
                                                          BILL
Bill No.    840
                                                                             M/s.:Bajaj Allianz General Insurance Co. Ltd
Date   :    26/11/2020                                                      2nd & 3rd floor, 4 Hathroi Fort, Gopalbari,
                                                                                    Ajmer Road, Jaipur-302001
                                                                              GSTI:
Claim No.              OC-21-1401-1801-00003526
Policy No              OG-21-2234-1801-00000213
Vehicle No.            GJ27AP6498
                                                                              Date of Accident:         20/11/2020
Insured Name        MS PRAKASH VAKTAJI MALI                    Date of Survey 23-11-2020
                                                      PARTICULARS                                                            AMOUNT
a Professional Fee                                                                          Final                               750.00
                                                                                                    Re-Inspection
b Halting Allowance
Conveyance Local)                                          Final & Re-Inspection                                       600.00
d) Fare From         Sirohi To
    By Car
    Distance 140KM*8=1120
(e)Speed Post=40                                                                                                                   40.00

                                                                                                                                        1,390.00
                                                                                    Add   CGST @ 9%
 PAN No. CZJPK1227R                                                         Add.   SGST @ 9%
                                                                                     Add.  IGST @ 18%
                                                                                                    Total                            1,390.00
 BANK -BANK OF BARODA                                                                                  AR
Address :- Shree Ji Plaza,Near Telephone Exchange,Pindwara-307022                    Hrte
A/c Name Mr. Dilip Kumar Prajapat A/c No. 55318100005070
 IFS Code BARB0PINSIR Branch Code 307012027                                                     Lay
                                                                                                                SLA-1206
                                                                                                         DILIP KUMAR PRAJAPAT

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