Gyan Rahash Tivari
                                                Surveyor & Loss Assessor
Licence No. SLA-38887                                                                              RESIDENCE:
Valid upto : 28-12-2023                                                                            MIG-55, Phase-II
                                                                                                          Kaushalpuri Colony
E-mail: gyan2500@gmail.com
                                                                                             Distt.- Faizabad-224 001 (U.P.)
IIISLA Membership No A/N/05766                                                         Mob.: 9415048094
Pan No.ACVPT9594P
GSTIN No- 09ACVPT9594P1ZT
     To,
      The Manager,
      Bajaj Allianj Genral Insurance Co. Ltd.
      4th floor, Habibulah estate, Halwasia commerce building, hazaratganj,
      Lucknow, Uttar Pradesh and mentioned below
      GST NO- 09AABCB5730G1ZV

     No.GPT/BAJAJ/(F)/20-21                                                             Date.13.03.2021
      Claim No. - 0C-21-1301-1802-00002146
     Vehicle no. UP42AH1037
      Insured      SURESH KUMAR TIWARI
      SI.                                          Particulars                                           Amount
      1    Final Survey Fee                                                                               750.00
      3    Local Canvence                                                                                350.00
       4    Photographs I C.D (Nos.)                                                                 0.00
       5    Other Expanses                                                                                    0.00
                                                                                  Total Amount Rs.     1200.00
                                                                                                        GST %         0.00
                                                                                                      Total Rs.    1200.00




                                                                                               (G.P. Tewari)

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