Yogesh Gupta
Surveyor& Loss Assessor
License No.     120998                                                    Office:                         SCF-10,Sector-6
Valid upto       20.01.2022                                                                       Bahadurgarh, Distt.Jhajjar
Deptt.             :Motor                                                                                            Haryana-124507
PAN No.         AIEPG3565C
                                                                                                                            M9728410038
Ref.No.YRK/Bajaj/20/Motor/155                                                                       October 17,2020
        Bajaj Allianz General Insurance Co.Ltd;
       Moti nagar
       Delhi.

                                           Policy No.      OG-21-2001-1802-00012103
                                           Claim No.       OC-21-1103-1802-00001937
                                         Vehilce No.       HR31M4995
                                 Insured's Name       :MR SHRI SUBHASH

                                                                  SURVEY FEE BILL

 A) Professional Fee for Spot survey                                                :Rs.                        0.00
 BProfessional Fee for Final survey                                                :Rs.                    500.00
       (Assessed loss amount Rs.)        11459.00
 cProfessional Fee for Re inspection/Others                                  :Rs.                        0.00
        Conveyance Charges (Local)                     1                                 :Rs.                    150.00
        Conveyance(Out Station)                          0             0                 :Rs.                        0.00
       Photographs-Digital                                   0             0                  :Rs.                        0.00
                                                                                                                                       650.00

                  Total Rs.650.00
       (Rs.SIX HUNDRED FIFTY ONLY.)


                         20998
                                      I
                         &LOSS
       (Yogesh Gupta)
        Surveyor and Loss Assessor
       NEFT Details:
       Name:               YOGESH GUPTA
       Bank:                INDUSIND BANK
       AlcNo.            159728410038

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