Licence No: SLA -31896 Tel.No.:28332089,28986989 Valid Upto :08/04/2022 Mobile No.:- 9821215937 DATTA M.KORE AUTOMOBILE SURVEYOR, LOSS ASSESSOR & VALUERS Email: datta.kore08@gmail.com C-107,Beach Classic Apt., Kanti Park,Shimpoli-Gorai Road, Chikuwadi, Borivali (W),Mumbai-92 FINAL SURVEY BILL INSURER : BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD. BILL NO: 613/20-21 BAGI Andheri Date : 22/10/2020 291, Xtrium, 2nd Floor, Next To Hoty Family Church, Andheri-Kurla Road, Chakala, Andheri (E), Mumbai-400099. State : Maharashtra - 27 GSTIN No. : 27AABCB5730G1ZX INSURED : NARESH SHARMA PoLICY NO. : OG-21-4180-1803-00000078 CLAiM No. : OC-21-1901-1803-00001124 VEHICLE NO. : MH 43 Y 9381 SURVEYED AT: NON TIEUP REPAIRER on Dt. : Details Amount Professional Fees SAC Code No. 997162 Rs. : 2,500.00 Photograph (@ Rs. 10.00 x 0 Copy) Rs. : 0.00 Conveyance () Rs. : 300.00 Total Rs. 2,800.00 CGST 9% On Rs. 2,500.00 Rs. : 225.00 SGST 9% On Rs. 2,500.00 Rs. : 225.00 Rounded to Nearest Rupees: Net Total Rs. : 3,250.00 Rupees : Three Thousand Two Hundred Fifty Onty GST No. : 27AAPPK5632B1ZS State : Maharashtra Code:27 PAN No.: AAPPK5632B STATE BANK OF INDIA DATTA CAM.KORE ORVEYOR ---PAGE END--- Printed On : 14-OCT-2020 Preliminary Survey Report Claim Id : 20324000 Claim No : OC-21-1901-1803-00001124 Customer Name : NARESH SHARMA Registration No : MH43Y9381 Survey Status : P Report Date : SurveyorRegion: BJAZ Address : Surveyor Address : Claimant Name : NARESH SHARMA Phone No : Date of Loss : 05-SEP-20 Mobile No : 9999999999 Claim No : OC-21-1901-1803-00001124 Survey Date : 06-OCT-20 Policy No : OG-21-4180-1803-00000078 Risk Start Date : 29-AUG-20 Risk End 28-AUG-21 Date : Data As Per Evidence Make TATA Model LPT 3718 Year of Manf 2016 Registration No MH43Y9381 Date Of Reg 10-SEP-2016 Chassis No 000000000000E11480 Engine No 00000000000063519102 Color Endt in RC No Speedometer Reading 1 Driver Name LAXMAN DL No 20090128670 Place of Issue MH01 Endt in DL HGV DL Endt Date DL Exp Date 19-MAY-22 Codification of Accident OG-21-4180-1803-00000078 Description of Loss DESC :- IV WAS ON THE WAY THAT TIME OTHER VEHICLE CAME SUUDENLY AND ACCIDEN HAPPEN DAM- MEGE :-FRRONT SIDE ARE DAMMEGE LOCATION :- MALKA PUR RATNAGIRI ROAD 1 i rr: ---PAGE END--- Preliminary Survey Report Claim No : OC-21-1901-1803-00001124 Survey Date :06-OCT-20 Surveyor Comments Damages are concurrent with statement of accident on claim form. Document Checklist Description Enclosed(Yes/No) Description Enclosed(Yes/No) Registration Cert Repairer Estimate Salvage Photo Satisfaction Voucher Photographs TL Report Driving License TP loss Report Damage Part Details M R : surveyor Sigha S- AuthBAGIC Signatufe ---PAGE END---