SAURABH JUNEJA
                                                       SURVEYOR&LOSSASSESSOR
                                     H.No. 107, Hargobind Enclave, 1st Floor,Vikas Marg Extn. Delhi-110092
License No. : SLA 73349                                                                 Mobile No.9899 474475
Valid Up to : 08-04-2023                                                                 E-Mail         :srbh.juneja@gmail.com
IIISLA No.:A/N/5997                                                                    Phone(s)        011-42058194

                                                                            Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                       Bill.No:B-01/21/04747
       Block No-4,7 Th Floor DLF Tower Shivaji Marg New Delhi-110015                 Date28/01/2021
       New Delhi-110015                                                                                      Code   :
       GSTIN:07AABCB5730G1ZZ              State Code : Delhi (07)
                  Report Ref No                     SJ/BAGI/4DJ9995/01-21/F/13205
                  Vehicle No.                         UP14DJ9995
                  Insured Name                    ANIL KUMAR TYAGI
                  Date Of Accident          :    09/01/2021
                  Policy/cover note no     :    OG-21-9906-1802-00273505
                  Claim No                      :    OC-21-1103-1802-00002978
   SNo                                       Particulars                                               HSN/SAC                               Amount
      1    Final                                                                                              997162                                        650.00
                    Professional Fee:       Assessed Amount 3,579.00                                          500.00
                     Photos/CD Expenses:                                                                                         0.00
                     0 Photographs ,Charged for 0 @ Rs.0.00
                     Conveyance Expenses:                                                                                   150.00

      2                Re-Inspection                                                                        997162                                        150.00
                                                                                                                                   Sub Total:                800.00
                                                                                                                               C GST @ 9.00 %                  72.00
                                                                                                                               S GST @ 9.00 %                  72.00
               ADVANCE RECEIPT                                                                                 Grand Total:               944.00
                                                                                                                                  Round off:               944.00
                                                           In words : Rs. Nine Hundred Forty Four Only
   GSTIN: 07AHGPJ3702K1ZG State : (07)
   PAN.AHGPJ3702K
   Bank Name:AXIS BANK
                                                                                                      S   BE
   A/c No.            913020019916326                                                                  00
   MICR No          110211039                                                     SAURABH JUNEJA

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