License No. SLA-73766 Valid Up to 05-10-2024 Mobile(S) : 990929990 Pan card no. AHRPA8488Q E-Mail :msadhikari77@gmail.com MANOHAR ADHIKARI Surveyor & Loss Assessor C/o Harinagar Nayak,Near DAV School, HaldwaniUttrakhand Survey Fee Bill To, Bajaj Allianz General Insurance Co. Ltd. Bill No.:B-02-24-02558 NEW DELHI Date 29/02/2024 NEW DELHI,WEST DELHI -110015 Code : GSTIN: 07AABCB5730G1ZZ State Code :NEW DELHI (07 Report Ref No : M S/BAGI/6ER4450/02-24/F/02666 Vehicle No. : UK06ER4450 Insured Name : RATAN DHALI Date Of Accident : 06-Feb-24 Assessed : 3,904.00 Policy/cover note no : OG-24-1157-1803-00000864 Estimate : 0.00 Claim No : OC-24-1103-1803-00002827 IDV : 90,000.00 SNO Particulars HSN/SAC Amount t 1 Final 997162 1,950.00 Professional Fee : Assessed Amount 3,904.00 850.00 Photos/CD Expenses: 0.00 0 Photographs,Charged for 0@ Rs. 0.00 Conveyance ExpenseVisted total 110 Kms.No ofvsts1charged10.0/Km 1,100.00 HALDWANI TO DINESHPUR 55*2 TOTAL 110KM Sub Total: 1,950.00 C GST @9.00% 175.50 S GST @9.00 % 175.50 ADVANCE RECEIPT Grand Total : 2,301.00 Round off : 2,301.00 In words: Rs. Two Thousand Three Hundred One Only GSTIN: 07AHRPA8488Q1Z9 State : (07) PAN.AHRPA8488Q Bank Name:HDFC BANK LTD A/CNo. 50200085453100 MANOHAR ADHIKARI MICR No 110240116 ---PAGE END---