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@rediffmaii.com
                                                                               Survey Fee Bill
To,
      Bajaj Allianz General Insurance Co. Ltd.                                                          Bill. No : RST/202919
      Rajkot                                                                                                            Date : 12/09/2020
      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/202919
                 Vehicle No.                    :    GJ10TX3492
                  Insured Name               :    Om Swachhatha Corporation
                  Date of accident            :    03-06-2020
                  Policy/cover note no     :    OG-20-2201-1811-00001424
                 Claim No                       :    OC-20-2201-1811-00001424
   S No                                        Particulars                                                 HSN/SAC                                Amount
     1    Final                                                                                                  997162                                       1800.00
                    Professional Fee :        Assessed Amount 3 50446.00                                         1500.00
                    Photos/CD Expenses :                                                                                           50.00
                     0 Photographs , Charged for 0 @ Rs. 50.00
                    Conveyance Expenses :                                                                                       250.00

                                                                                                                                       Sub Total : %              1800.00
                                                                                                                                   C GST @ 9.00 %                162.00
                                                                                                                                   S GST @ 9.00 %                162.00
               ADVANCE RECEIPT                                                                                    Grand Total :               2124.00
                                                                                                                                       Round off :              2,124.00
                                               In words : Rs. Two Thousand One Hundred Twenty Four Only
                                                                                                                                                                  TH
  GSTIN: 24AAUPT4514C1ZN State : (24)                                                                                          SURVEYOR
  PAN. : AAUPT4514C                                                                                                                  A      1Y
                                                                                                                                                    R   2          0
  Bank Name : HDFC Bank Ltd.,                                                                                                           SSTESESSOR
                                                                                                                                                                          *
                                                                                                                                                      t*e
  A/c No.             01771500003760
  MICR No           361240001
  IFS Code          : HDFC0000177






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