Ali Imran Sayeed
                                                                                           INSURANCE SURVEYOR & LOSS ASSESSOR IRDA
                                                                                         LICENCE NO- SLA74708, VALID UPTO- 19.12.2022
                                                                                  Phone- +91 8888865478. Email-reachaliimran@gmail.com
Bill No.:      20/03/859                                                                        Date: 20-Oct-20
To,
          M/S BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
                  BLOCK NO 603, 7TH FLOOR, SHRI RAM SHYAM TOWER,
                  KINGSWAY, SADAR, NEAR NIT BUILDING,
                  NAGPUR 440001 Phone No 0712-3052136
                  GSTIN Number : 27AABCB5730G1ZX

Subject :              Kindly arrange to pay the survey fees for above bill no of                 Rs. 1,121

Insurer                           BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.BLOCK NO 603, 7TH FLO
Policy No                        OG-21-9910-1870-00001278
Claim No                         OC-21-2101-1870-00000116
Policy Holder                  MAYUR ARVIND JIRAPURE
Vehicle No                      MH29BC7196
Survey Dated                  16-0ct-20                                                              LOCATION :
Place of survey                SAI AUTO                                                              YAVATMAL
Total Assessment             Rs. 8,100
Remark

Particulars                                                      SAC CODE
Professional Fees FINAL                                          997162                       Rs              750|
Photographs                                                         997162                       Rs                  0
                                                             1           997162                                          200
Conveyance (To & Fro in Kms)                                                                   Rs
RE-INSPECTION                                                    997162                       Rs                  o
Spot Conveyance (To & Fro in Kms)                              997162                       Rs                  0
                                                                                          Total                        Rs.950|
Add CGST @ 9% (GST NO 27BQFPS9700K1ZC)                                                              Rs.86
Add SGST @ 9% (GST NO 27BQFPS9700K1ZC)                                                               Rs.86
Add IGST @ 18% (GST NO 27BQFPS9700K1ZC)                                                                    0
                                                                     Total Bill Amount                        Rs. 1,121
In words:

PAN No.                      BQFPS9700K

   GST NO               27BQFPS9700K1ZC                                                        SAYE
                                                                                                                  SLA
SAC CODE                       997162
                                                                                                                 74708
STATE
                                27 Maharashtra
CODE
                                                                                                            (Ali Imran Sayeed)

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