MAHESH PRAIAPATI                                Contact No.:7574844245
 SURVEYOR&LOSS ASSESSOR&VALUER                           22, Vaikunth Park Society, Nr.Ashruti Tenament,
 Promoted By IRDA,Govt.of India                                                                        Jitodia Road,Anand-388001
SLA NO. 85079 Valid up to 09.10.2022                       Email : mahesh.bagic@gmail.com

                                                    Bill Cum Advance Receipt
                                                                     Invoice No.      277
                                                                     Invoice Date     21.12.2020
Ins Comp.   BAJAJALLIANZ GENERAL INS CO LTD                           GSTIN      24AABCB5730G1Z3
                  VADODARA                                 Nature of Loss : Own damage/repair/spot
Insured     MR. MANISHKUMAR B PATEL           Vehicle No.      GJ23BL5681
 Clalim No.  OC-21-2201-1801-00004062                                    Policy No.OG-21-2201-1801-00007267
   Sr.No.                DESCRIPTION                    QTY.          UNIT      RATE             Rs.Ps.
      01      Survey Fees -OD                                    1               Per          750                         750.00
       01      Survey Fees -Spot                                  1               Per            0                              0.00
       02      Re inspection Fees                                  1               Per            0                               0.00
       03      Daily Allowance                                      1              Each           0                               0.00
       04      Local Conveyance Charges                       1              Each         300                         300.00
                 Re Inspection visits/Spot                         1              Each           0                               0.00
                  Outstation Conveyance Charges               1               Km            0                               0.00
      05      Photograph (CD) Charges                        1              Each           0                               0.00
      06      Other Expense/Toll Taxes                                                                                            0.00
                                                                    Sub Total                                                            1050.00
GSTIN        24APMPP3544B1Z2                        SGST @           9.00%                                              94.50
SACCODE   997162                                         CGST@           9.00%                                              94.50
                                                                    Grand Total                                                         1239.00
Rupees:One thousand two hundred thirty nine only.

E.andO.E.                                                                            Bank Details:
Subject to Anand Jurisdiction                       PRA                    ICICI Bank - Anand (Gamdivad Branch-0256)
Pan No.:APMPP3544B
                                                          SH
                                                               a                        Account No.:000301531217
SAC CODE997162                                 SURVEYOR                  IFSC CodeICIC0000256
                                                             SLA-36079                   Account Type : Savings
                                                          0

MAHESH PRAJAPATI

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