ANUJ KUMAR AGARWAL
                                                                                Surveyor & Loss Assessor                           Tel. 01342-262305
                                                                         License No. SLA 25892, Exp. 09.11.22                     Mob. 9412215972
                                                                    Fellow Member , Dep. Motor, Marine & Engg.                Email a_bijnor@yahoo.com
                                                                                                                                                  Add. H.N. 360, State Bank Colony,
                                                                                                                                                  Nai Basti, Bijnor-246701

                                                                                        Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                           Bill. No : B-09/20/00443
       LUCKNOW                                                                                                                   Date     : 18/09/2020
      4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ                               Code     :
       LUCKNOW
      GSTIN: 09AABCB5730G1ZV                      State Code: UP (09)
                   Report Ref No                           AK/BAGI/AT-6945/09-20/F/02844
                   Vehicle No.                         :     UP20AT 6945
                   Insured Name                    :     ALI NAMAZ
                   Date Of Accident          :            10/09/2020
                   Policy/cover note no           :     OG-20-3646-1803-00000205
                   Claim No                           :    OC-21-1301-1803-00000480

    S No                                              Particulars                                                         HSN/SAC                                      Amount Z
      1     Final                                                                                                              997162                                                 650.00
                      Professional Fee :             Assessed Amount  -500.00                                                            500.00
                      Photos/CD Expenses :                                                                                                             0.00
                       0 Photographs , Charged for 0 @ Rs. 10.00
                      Conveyance Expenses :                                                                                                        150.00

                                                                                                                                                       Sub Total : %                    650.00
                                                                                                                                                   C GST @ 9.00 %                      58.50
                                                                                                                                                  S GST @ 9.00 %                      58.50
                                                                                                                                                    Grand Total : %                    767.00
                                                                                                                                                       Round off : %                    767.00
                                                                      In words : Rs. Seven Hundred Sixty Seven Only
  GSTIN: 09 ADGPA7680K1Z8 State : (09)
  PAN. : ADGPA7680K
  Bank Name : STATE BANK OF INDIA
  A/c No.                : 31013997566
  MICR No              : 264002303                                                               ANUJ KUMAR AGARWAL

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