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

                                                             SURVEY FEEBILL

                                                                                   TAX INVOICE
To,                                                             BILL NO.                  2248-01-2020-21
Bajaj Allianz General Insurance Co. Ltd. (Regional OfficDATE                     29-01-2021
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-21-2203-1802-00001125
REPORT NO              VD/BAGIC/01/2021/2248                                                                DATE OFLOSS          14-Jan-2021
INSURED                 GAUTAMBHAI RAGHAVBHAI BHOJANI                                             DATE OF SURVEY       18-Jan-2021
POLICY NO.              OG-21-2203-1802-00000975
VEHICLE REGN. NO.      GJ05 MD 9070                   MAKE                    H CB Shine                PLACE OF SUPPLY           GUJARAT
ESTIMATED LOSS       Rs.5,900                           ASSESSED LOSS                                        STATE OF SUPPLY           GUJARAT
DESCRIPTION                                                         NO./KM                   RATE                AMOUNT
01.PROFESSIONALFEES                                                                                                      Rs.          500.00
SPOT SURVEY
FINAL SURVEY                                                                                                      Rs.           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.        1,000.00
                                                                           CGST                     @                       9%            Rs.            90.00
  HSN/SAC CODE
                               TAXES (00440169)             SGST                     @                       9%            Rs.            90.00
        997162                                                        IGST                      @                                         Rs.
TOTAL:                                                                                                                                             Rs.        1,180.00
TOTAL AMOUNT WITH TAX:                                                                                                         Rs. 1,180.00
                                                                                              Rupeess One Thousand One Hundred Eighty Only
  HSN/SAC CODE                997162
                      CENTRAL TAX                                          STATE TAX                                   INTERSTATE TAX
         RATE                       AMOUNT                      RATE                 AMOUNT                RATE                 AMOUNT
           9%                          90.00                          9%                     90.00
  TAXABLE VALUE   Rs.                    1,000.00
    TOTAL TAX RS.     Rs.                      180.00

             GSTIN No.: 24AJAPD3623K1ZN                                 KM.
                                                                                 VIVE
               PAN No.: AJAPD3623K
E &OE PRE RECEIPTED
                                                                                     S                                    V.M.DesaiQ
                                                                                                                            VIVeK MDeSAT
                                                                                                                           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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