Vivek M. Desai
                                               Surveyor  Loss Assessor.(Motor
Licence No.: S.L.A. 73760                                                                              Address:          29, Anand Nager Society, Morabhagal,
Valid upto: 03rd Oct.2021.                                                                                                              Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                               (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                              SURVEYFEEBILL
                                                                                    TAX INVOICE
To,                                                              BILL NO.                  2284-02-2020-21
Bajaj Allianz General Insurance Co. Ltd. (Regional Offic DATE                     17-02-2021
4th Floor, Atlantis Heritage,
Opp-Swagat Petrol Pump,                                      Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
Sarabhai Road, Vadodara -390007                        Office Code
           GSTIN No.24AABCB5730G1Z3         Claim No                  OC-21-2203-1803-00000368
REPORT NO               VD/BAGIC/02/2021/2284                                                                 DATE OFLOSS          1-Feb-2021
INSURED                 AFSARKHAN PATHAN                                                                    DATE OF SURVEY       3-Feb-2021
POLICY NO.               OG-21-2202-1803-00008871
VEHICLE REGN. NO.      GJ05 CT 2757                    MAKE                     Baja Rikshaw              PLACE OF SUPPLY            GUJARAT
ESTIMATED LOSS       Rs.20,500                          ASSESSED LOSS                                         STATE OF SUPPLY           GUJARAT
DESCRIPTION                                                          NO./KM                   RATE                 AMOUNT
01.PROFESSIONALFEES                                                                                                        Rs.           500.00
SPOT SURVEY
FINAL SURVEY                                                                                                       Rs.           500.00
RE-INSPECTION
02.EXPENSES                                                                                                                             Rs.           350.00
PHOTOGRAPH                                                                           Rs.                        Rs.
CONVEYANCE CHARGES                                                           Rs.             350.00  Rs.           350.00
HALTING ALLOWANCE                                                                                             Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                  Rs.
OUTSTATION TRAVELLING EXPENSES                                                                     Rs.
                  FROM
                       TO                                                                     Rs.                        Rs.
03.TOTAL FEES:                                                                                                                          Rs.           850.00
                                                                            CGST                     @                        9%            Rs.            76.50
  HSN/SAC CODE
                                TAXES (00440169)             SGST                      @                        9%            Rs.            76.50
        997162                                                         IGST                      @                                          Rs.
TOTAL:                                                                                                                                               Rs.        1,003.00
TOTAL AMOUNT WITH TAX:                                                                                                           Rs. 1,003.00
                                                                                                                         Rupeess One Thousand Three Only
  HSN/SAC CODE                997162
                       CENTRAL TAX                                           STATE TAX                                   INTERSTATE TAX
          RATE                       AMOUNT                      RATE                 AMOUNT                 RATE                 AMOUNT
            9%                           76.50                           9%                     76.50
  TAXABLE VALUE   Rs.                      850.00
    TOTAL TAX RS.     Rs.                      153.00

             GSTIN No.: 24AJAPD3623K1ZN
               PAN No.: AJAPD3623K
E&OE PRE RECEIPTED                                                      FO                                 U.M Desai
                                                                         S
                                                                                 3/60
                                                                                                                              Vivek M desai
                                                                                                                              Surveyor & Loss Assessor.
* Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No: 73760,Valid Upto:03/10/2021.

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