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.:      20/03/1198                                                                        Date: 18-Dec-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                         0G-21-3446-1801-00000004
Claim No                          0C-21-2101-1801-00001262
Policy Holder                   CHANDRAKANT SHANTLINGAPPA MARPALIKAR
Vehicle No                       MH09BM8407
Survey Dated                   8-Dec-20                                                                LOCATION :
Place of survey                VIJAY MOTORS                                                        YAVATMAL
Total Assessment             Rs.9,500
                                                                      D
Remark

Particulars                                                       SAC CODE
Professional Fees FINAL                                          997162                        Rs               750|
PHOTOS                                                               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
                                                                                                                       SLA
SAC CODE                       997162
                                                                                                                      74708
STATE
                                27 Maharashtra
CODE
                                                                                                              (Ali Imran Sayeed)

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