VIKRANT GUPTA
                  B.E(Mech                                                    Mobile No.09811085077
                                                                                   Office cum Resi.
                                                                                   273.Tagore Park.Behind Canaa
                                                                                   Bank Near Model Town-1 Deh-9
                                     Insurance Surveyor & Loss assessor
        SLA No68550                                                                    PAN NO.AENPG365M
        Expiry O.10/112021
                                           SURVEY FEE &EXPENSES BILL
           Ref.No.:VG/BJ/484/2020                                                        Date :13.11.2020
         1INSURER                  M/S Baaj Allianz General Insurance Co.Ltd.
                                          th Floor.DLF Tower.Shivi Marg.New De-15
                                          GSTin No.:07AABCB5730G1ZZ
        2INSURED                   SYED ADEEL RAZA

       3 Vehicle No.                 UP 16BH 8219
       4 CLAIM No.                  OC-21-1103-1802-00002196

     Professional Fee                                                               400.00
    Re-inspection Survey Fees                                                     0.00
    Conveyance Charges for Final Survey                                      150.00
   Conveyance During Repair                                                     0.00
   Conveyance Charges for Re-inspection                                     150.00
   Other Charges                                                                      0.00

  TOTAL                                                                              700.00
  GROSS TOTAL                                                                    700.00

 Please issue cheque for the above said amount in the favour of Mr. VIKRANT GUPTA to be
drawn on CANARA BANK, A/C No.2592101002205,Model Town Branch,IFSC Code:
CNRB0002592.



VIKRNT GUPTA

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