Vivek M. Desai
                                              Surveyor & Loss Assessor.(Motor)
Licence No.: S.L.A. 73760                                                                            Address:          29, Anand Nager Society,Morabhagal,
Valid upto: 03rd Oct. 2021.                                                                                                           Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                              (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                             SURVEYFEEBILL
                                                                                   TAX INVOICE
To,                                                             BILL NO.                  2164-12-2020-21
Bajaj Allianz General Insurance Co. Ltd. (Regional OfficDATE                     04-12-2020
4th Floor, Atlantis Heritage,
Opp-Swagat Petrol Pump,                                     Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
Sarabhai Road, Vadodara -390007                        Office Code
           GSTIN No. 24AABCB5730G1Z3         Claim No                  OC-21-2203-1801-00002591
REPORT NO              VD/BAGIC/11/2020/2164                                                                DATE OF LOSS          [31-Oct-2020
INSURED                 PRAMOD SHISHRAM SINGH                                                           DATE OF SURVEY       3-Nov-2020
POLICY NO.              OG-21-9906-1801-00063641
VEHICLE REGN. NO.      GJ05 JH 4909                   MAKE                     H Mobilio                   PLACE OF SUPPLY           GUJARAT
ESTIMATED LOSS       Rs.1,80,000                       ASSESSED LOSS                                       STATE OF SUPPLY           GUJARAT
DESCRIPTION                                                         NO./KM                   RATE                 AMOUNT
01.PROFESSIONALFEES:                                                                                                      Rs.        2,500.00
SPOT SURVEY
FINAL SURVEY                                                                                                      Rs.        2,500.00
RE-INSPECTION
02.EXPENSES                                                                                                                           Rs.          500.00
PHOTOGRAPH                                                                          Rs.                        Rs.
CONVEYANCE CHARGES                                           2             Rs.             250.00  Rs.           500.00
HALTING ALLOWANCE                                                                                           Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                 Rs.
OUTSTATION TRAVELLING EXPENSES                                                                    Rs.
                  FROM
                      TO                                                                   Rs.                        Rs.
03. TOTAL FEES:                                                                                                                       Rs.       3,000.00
                                                                           CGST                     @                        9%            Rs.          270.00
  HSN/SAC CODE
                                TAXES (00440169)            SGST                     @                       9%            Rs.          270.00
        997162                                                        IGST                      @                                         Rs.
TOTAL:                                                                                                                                             Rs.       3,540.00
TOTAL AMOUNT WITH TAX:                                                                                                         Rs. 3,540.00
                                                                                             Rupeess Three Thousand Five Hundred Forty Only
  HSN/SAC CODE                997162
                      CENTRAL TAX                                          STATE TAX                                   INTERSTATE TAX
          RATE                       AMOUNT                      RATE                 AMOUNT                RATE                 AMOUNT
           9%                         270.00                          9%                    270.00
  TAXABLE VALUE   Rs.                    3,000.00
    TOTAL TAX RS.     Rs.                      540.00

             GSTIN No.: 24AJAPD3623K1ZN
               PAN No.: AJAPD3623K
E&OE PRE RECEIPTED
                                                                                                                           V.M.Desei
                                                                                                                            Vivek m Desai
                                                                                                                            Surveyor & Loss Assessor.
* Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No: 73760, Valid Upto: 03/10/2021.

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