Lic.no.: 26815/Exp. 28.01.2023         B.K.Gupta       Surveyor, Loss Assessor & Valuer
                                           2-Ka-15, Dadabari, Kota-9
Phone : 94141-88998                                           E-mail : bkgsurvey@yahoo.co.in
GSTI No.:08ABYPG9645A1ZA                                             PAN No.: ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB573OG1ZX
Bill no.:  Baj-210                                                                          Date : 23.03.2021
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c: Mr.Nane Bhai
Reg.: Final Survey of Vehicle no. RJ-17-SQ-0206
Policy/C.note no./Period : OG-21-2101-1843-00001237 / 11.03.2019 to 10.03.2022
Claim no. : OC-21-1401-1843-00000153                        S/Allott.Date :18.03.2021
Date of Loss : 03.03.2021                                             S/Rep.no.: Bajaj/MT/20-21/210
                                                                                                     Rs.         500.00
2. Photographs CD                                                                         Rs.            0.00
3.Local Conveyence                                                                     Rs.            0.00
4. Out station Expanses : Kota to Khanpur                                          Rs.       2057.00
     (242 Kms to & fro) @ 8.5/Km.
5.Haulting Allownce: 1/2 day                                                           Rs.         175.00
6.Other Expanses                                                                           Rs.
                                                                                                                 2732.00
                                                                      CGST    9.00%         Rs.         245.88
                                                                       SGST    9.00%         Rs.         245.88
                                                                               Total              Rs.       3223.76
(Rupees Three Thousand Two Hundred Twenty Three Paisa Seventyy Six Only)

---PAGE END---