HEMANT R. PANCHAL
                                                   Surveyor & Loss Assesor
                      A-203, 2nd floor, Rushi Complex, Beside Hari Om Petrol Pump, L.P. Savani Road,
                                            Adajan, Surat - 394510. Mobile: 98244 -75769.
                                                 Lic. No. 58125 Valid upto 30/01/2023.
                                                                SURVEY BILL
       To,
       Bajaj Alianz Gen. Ins. Co. Ltd.
       Gujarat
       GST No.24AABCB5730G1Z3

      Bill /Ref. No. :                                HP/VAL/022/2020              Date:                     30/09/2020
      Policy No                                      0G-20-2203-1801-00012544
      Claim No.                                      0C-21-2203-1801-00001043
     Insured                                        HARISHBHAI SOLANKI
     Vehicle no.                                     GJ05JA5252
                                                                                                                        Amount
                                                                                                                        Rs. Rs.
    01. Survey Fees                                                                                                           500

   02. Out Station Allowance

  03. Travelling & Conveyance charges

 04. Photographs Charges
 05. 0ther Exps.
                                                                                                                                    500
Add:GST                                           CGST                         09%                                 45
GST No.24AIWPP4714A1ZA              SGST                          09%                                 45
PAN no.AIWPP4714A                        IGST                          00%
                                                          ADVANCE RECEIPT    Total Rs.                        590


                                                                                   HEMANT/R. PANCHAL
                                                                              SURVEYOR &'LOSS ASSESSORS4    SURAT
                                                                                                                           FYOR              W

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