Rajesh S. Thakker
                                                                                                            C.A.E., D.A.E., A.I.S.A.
                                                                     SURVEYOR, LOSS ASSESSOR & VALUER
                                                                           Licence No. SLA 20725 Exp. Dt. 17-08-2021
                                          5, PATEL COLONY, ROAD NO. 1, OPP. DARSHAN APARTMENT, JAMNAGAR - 361 008, (GUJARAT)
                                                          MO. 98242 11549, 94274 45301 E-mail : rajesh_thakker@rediffmail.com
                                                                                       Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                          Bill. No : RST/202994
      Rajkot                                                                                                                       Date     : 17/10/2020
      1st Floor, Hotel K Rose Building, In Front Of Shastri Medan, Limda Chowk,                           Code     :
      Rajkkot
      GSTIN: 24AABCB5730G1Z3                     State Code: Gujarat (24)
                   Report Ref No                    :     RST/202994
                   Vehicle No.                        :     GJ10TX3140
                   Insured Name                    :     Om Swachhata
                   Date of accident                 :     14-09-2020
                   Policy/cover note no           :     OG-20-2201-1811-00001698
                   Claim No                           :    OC-21-2204-1811-00000010

    S No                                              Particulars                                                         HSN/SAC                                     Amount /
      1     Final                                                                                                             997162                                              1550.00
                      Professional Fee :             Assessed Amount  23200.00                                                       1250.00
                      Photos/CD Expenses :                                                                                                          50.00
                       0 Photographs , Charged for 0 @ Rs. 50.00
                      Conveyance Expenses :                                                                                                       250.00

                                                                                                                                                      Sub Total : %                  1550.00
                                                                                                                                                  C GST @ 9.00 %                    139.50
                                                                                                                                                 S GST @ 9.00 %                    139.50
                ADVANCE RECEIPT                                                                                                     Grand Total : %                  1829.00
                                                                                                                                                     Round off :                 1,829.00
                                                           In words : Rs. One Thousand Eight Hundred Twenty Nine Only
  GSTIN: 24AAUPT4514C1ZN State : (24)
  PAN. : AAUPT4514C
  Bank Name : HDFC Bank Ltd.,
  A/c No.                : 01771500003760
  MICR No              : 361240001

---PAGE END---