B.K.Gupta       Surveyor. Loss Assessor & Valuer
Lic.no.: 26815/Exp. 28.01.2023
                                           2-Ka-15,Dadabari,Kota-9
Phone :94141-88998                                           E-mail:bkgsurvey@yahoo.co.in
GSTI No.: 08ABYPG9645A1ZA                                             PAN No. : ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no.Baj-138                                                                           Date : 31.12.2020
Issued to.
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c:Mr.Giriraj
Reg.: Final Survey of Vehicle no. RJ-08-SR-9300
Policy/C.note no./Period : OG-20-3282-1802-00000014 /25.11.2020 to 24.11.2021
Claim no.:OC-21-1401-1802-00000965                        S/Allott.Date :11.12.2020
Date of Loss : 07.12.2020                                             S/Rep.no.: Bajaj/MT/20-21/138
                                                                                                      Rs.         500.00
2.Photographs CD                                                                          Rs.            0.00
3.Local Conveyence                                                                      Rs.            0.00
4.Out station Expanses:Kota to Bundi                                              Rs.         731.00
     (86 Kms. To & fro) @ 8.50/Km/
5.Haulting Allownce:1/3 day                                                           Rs.         117.00
6.Other Expanses                                                                           Rs.
                                                                                                                   1348.00
                                                                       CGST    9.00%         Rs.         121.32
                                                                        SGST    9.00%         Rs.         121.32
                                                                                Total              Rs.       1590.64
(Rupees One Thousand Five Hundred Ninty Paisa Sixty Four Only)

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