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-01/21/00843 LUCKNOW Date : 05/01/2021 4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ Code : LUCKNOW GSTIN:09AABCB5730G1ZV State Code : UP (09) Report Ref No : AK/BAGI/BJ-3920/01-21/F/03242 Vehicle No. : UP20BJ 3920 Insured Name : HARSH KUMAR KASHERWA Date Of Accident : 22/11/2020 Policy/cover note no : OG-19-3030-1828-00000182 Claim No : OC-21-1301-1828-00000284 S No Particulars HSN/SAC Amount 1 Final 997162 1,200.00 Professional Fee : Assessed Amount -100.00 500.00 Photos/CD Expenses : 0.00 0 Photographs , Charged for 0 @ Rs. 10.00 Conveyance Expenses : 700.00 BIJNOR TO NAJIBABAD 70 KM 2 DA Half Day 997162 175.00 Sub Total : 1,375.00 C GST @ 9.00 % 123.75 S GST @ 9.00 % 123.75 Grand Total : 1,622.50 Round off : 1,623.00 In words : Rs. One Thousand Six Hundred Twenty Two Only GSTIN: 09 ADGPA7680K1Z83 State : (09) PWAL PAN. : ADGPA7680K Bank Name : STATE BANK OF INDIA A/c No. 31013997566 SURVEYOR 0 MICR No 264002303 ANUJ KUMARSAGARWAL IFS Code : SBIN0000621 Surveyor & Loss Assessor ---PAGE END---