ANUJ KUMAR AGARWAL
                                                                    Surveyor & Loss Assessor                      Tel. 01342-262305
                                                              License No.SLA 25892, Exp. 09.11.22                Mob.9412215972
                                                        Fellow Member, Dep. Motor, Marine & Engg.         Email a_bijnor@yahoo.com
                                                                                                                                 Add. H.N.360, State Bank Colony
                                                                                                                                 Nai Basti, Bijnor-246701

                                                                            Survey Fee Bill
To,
      Bajaj Allianz General Insurance Co. Ltd.                                                        Bill. No : B-12/20/00788
      LUCKNOW                                                                                                   Date 24/12/2020
      4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ         Code   :
      LUCKNOW
      GSTIN: 09AABCB5730G1ZV              State Code : UP (09)
                 Report Ref No               :    AK/BAGI/BR-9493/12-20/F/03187
                 Vehicle No.                   :   UP20BR 9493
                 Insured Name               :    VANDNA AZAD
                 Date Of Accident                22/11/2020
                 Policy/cover note no     :    OG-20-3646-1826-00000004
                 Claim No                      :    OC-21-1301-1826-00001803

   S No                                       Particulars                                               HSN/SAC                               Amount 
      1    Final                                                                                               997162                                        500.00
                    Professional Fee :       Assessed Amount  -100.00                                            500.00
                    Photos/CD Expenses :                                                                                         0.00
                    0 Photographs , Charged for 0 @ Rs. 10.00
                    Conveyance Expenses :                                                                                        0.00

                                                                                                                                   Sub Total :                500.00
                                                                                                                              C GST @ 9.00 %                 45.00
                                                                                                                              S GST @ 9.00 %                 45.00
                                                                                                                               Grand Total :                590.00
                                                                                                                                  Round off :                590.00
                                                              In words : Rs. Five Hundred Ninety Only
  GSTIN: 09 ADGPA7680K1Z8 State : (09)
  PAN. : ADGPA7680K
  Bank Name : STATE BANK OF INDIA
  A/c No.            : 31013997566                                                                      SURVEYOR
  MICR No          : 264002303                                                    ANUJ KUMAR AGARWAL
  IFS Code         : SBIN0000621                                                   Surveyor & Loss Assessor

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