"Original For Recipient"
 Priority Insurance Surveyors & loss Assessors Pvt Ltd
 202-203, 2nd Floor, Abhishree Adroit, Nr. Gwaliya Sweets, Mansi                                                         PRIORITY
 Cross Road, Vastrapur, Ahmedabad, Gujarat -- 380015
 Phone #: +91 7940029357
 Email : accounts@prioritysurveyors.co.in
                                                                        Tax Invoice
 To,                                                                                                                Invoice No3111-2010-0012
 Bajaj Allianz General Insurance Company Ltd                                                   Invoice Date : 17/10/2020
 4nd Floor ,Turquoise ,Near Panchvati Circle, CG Road
 ,Ellisbridge, Ahmedabad.


State       : Gujarat (Code -24)
 GSTIN No : 24AABCB5730G1Z3
Place of Supply : Gujarat
 Insured                      Kusumben Ramgopal                   Vehicle Number          GJ-01-DU-5672
Policy #                     OG-20-2202-1803-00026455         Nature Of Loss           Own Damage
 Claim #                      OC-21-2202-1803-00000414         Type of Vehicle           Truck

  SR.NO.                           DESCRIPTION                              QTY.        UNIT        RATE         AMOUNT
       1      Survey Fees                                                              1           Each       3750.00              3750.00
       2      Local Conveyance Charges - 1st Visit                             1           Each        500.00                 500.00
                                                                                                          Sub Total                                4250.00
                                                                                                          CGST @   9.00%                     382.50
                                                                                                          SGST @    9.00%                     382.50
                                                                                                          Grand Total                             5015.00
                                                                                                         Say                                           5015
                                                      INR : FIVE THOUSAND FIFTEEN ONLY

E. and O.E.                                                                         Bank Details
Subject to Ahmedabad Jurisdiction                                      Bank Name     :HDFC Bank Ltd
GSTIN No                         : 24AAECP6441K1ZB                   A/C No           00692560008630
HSN/SAC Code                 997169                                     IFSC Code      HDFC0000069
PAN No                            : AAECP6441K                            Micro Code      380240005
Survey License No              72461/2018-2021                      Branch           : Ashram Road, Ahmedabad
Corporate Identity Number   :U74120GJ2008PTC053700
For Prigvetornarance Surveyors & Loss Assessors Pvt. Ltd
                         1
                           0
                 MEDABAB
Authorized*Signatory

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