Er.KANHAIYA CHAUHAN
            Govt.Approved
SURVEYOR &LOSS ASSESSOR
INVESTIGATER,VALUER & CLAIM ADVISER
SPECIALIST IN MOTOR CLAIM`S
GST NO 09AENPC3685E1ZD
PAN NO.AENPC3685E
LICENCE NO.SLA-120150

BILL NO. MOTOR/FINAL/BAJAJ/402/20-21                                               DATE 29.01.2021

    INSURERS                                BAJAJ ALLIANZ GENERAL INSURANCE CO. Ltd.
     ADDRESS                                 THE SILVER LINE,11/9,CIVIL LINES KANPUR
    INSURED                                  Mr Shobhit Gupta                   MODEL          Hero Ignitor
                                               ;
     POLICY/COVER NOTE      :     OG-19-3640-1843-00000019    VEHICLE NO. UP78 DC 1371
     CLAIM NO.                         :     OC-21-1302-1843-00000451
     DATE OF ACCIDENT          :     23.01.2021                     DATE OF SURVEY 26.01.2021

                                                                                           Amount (Rs.)|Pa.

1. Survey Fee                                                                          500        00
                                    covered 100 km From Panki to Guru Baba
2. Conveyance           Motors SHIVALI Akbarpur Ramabai nagar       750
                                                    & back @ 7.5/km                                     00
3.C D charges                                                                                       00
 4 Re-Inspection
 5 S GST                           9% on the Gross Fee Amount              112
 6 C GST                             9%on the Gross Fee Amount               112
 7 Toll Tax
                                                                                G Total[     1474       00

Rupee One thousand four Handred Seventy four only.

     Cheque No :                                                                  Bank A/c No.20006890666
                                                                                           IFS code SBIN0000242
     Date:                                                                            Stae Bank of india


     E.&O.E.                                                                                     Kanhaiya Chauhan SLA-120150

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