PARESH KOTHARI
                                          Approved Consulting Automobile and Engineering Surveyor, Loss Assessor & Valuer
S.L. NO. SLA -66761                                                                                                                    2C SONAL APRTMENT,
Dt. Exp. : 29-11-2021                                                                                                                  2 MARUTINAGAR,
Mobile : 9825072771                                                                                                                  NEAR AIRPORT,RAJKOT -360001
pareshkothari1@gmail.com
                                                                               Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                         Bill. No : B-01-21-04243
       VADODARA                                                                                                    Date   21/01/2021
       401,ATLANTIS HERITAGE,OPP.SWAGAT PETROL PUMP,SARABHAI MAIN   Code   :
       ROAD, NEAR GENDA CIRCLE
       GSTIN: 24AABCB5730G1Z3              State Code : Gujarat (24)
                  Report Ref No               :    VKP/BAGI/-T-8480/01-21/F/04292
                  Vehicle No.                   :    GJ36T 8480
                  Insured Name              :    Ravikumar P Khambhala
                   Date Of Accident           :    29-Dec-20
                  Policy/cover note no    :    OG-21-2221-1803-00000182
                  Claim No                      :    OC-21-2204-1803-00000367

   S No                                        Particulars                                                HSN/SAC                               Amount 
      1    Final                                                                                                 997162                                     2,800.00
                     Professional Fee :       Assessed Amount & 135,000.00                                    2,500.00
                     Photos/CD Expenses :                                                                                         50.00
                      1 Photographs , Charged for 1 @ Rs. 50.00
                     Conveyance Expenses :                                                                                     250.00

                                                                                                                                      Sub Total:            2,800.00
                                                                                                                                  C GST @9.00 %                252.00
                                                                                                                                  S GST @ 9.00 %                252.00
               ADVANCE RECEIPT                                                                                  Grand Total :            3,304.00
                                                                                                                                     Round off :            3,304.00
                                                   In words : Rs. Three Thousand Three Hundred Four Only
   GSTIN: 24ADNPK4533G1ZM State :(24)                                                                            Advance Receipt
   PAN. : ADNPK4533G                                                                                                          Paresh Kothari
                                                                                                           PARESH KOTHARI
   Bank Name : Bank of Baroda                                                                                                           Yaruas
   A/c No.             7460100005184
   MICR No          360012006                                                                                               Surveyor and Assessor

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