VIKRANT GUPTA
                  B.E (Mech )                                                                         Mobile No. : 09811085077
                                                                                                            Office cum Rosi.:
                                                                                                            273,Tagore Park,Behind Canara
                                                                                                            Bank,Near Model Town-i,Delhi-9
                                            Insurance Surveyor & Loss assessor
    SLANO     66550                                                                                 PAN No. : AENPG 3555M
    Expiry On. : 10/11/2021                                                                             GSTin No.: 07AENPG3555M1Z3
                                                     SURVEY FEE & EXPENSES BILL
          Ref. No. : VG/BJJ/325/2020                                                                             Date : 30.09.2020
      1 INSURER                        : M/S Bajaj Allianz General Insurance Co. Ltd.,
                                                    7th Floor, DLF Tower, Shivaji Marg, New Delhi-15
                                                     GSTin No.: 07AABCB5730G1ZZ
     2 INSURED                        : MR CHANDRAPAL SINGH

     3 Vehicle No.                        UP 16BF 4381
     4 Claim No.                        OC-21-1103-1802-00001640
                                                                                        HSN/SAC
 Professional Fee                                                                 997162       400.00
 Re-inspection Survey Fees                                                                       0.00
 Conveyance Charges for Final Survey                                                   150.00
 Conveyance During Repair
 Conveyance Charges for Re-inspection                                                     0.00
 Other Charges                                                                                             0.00
TOTAL                                                                                                      550.00
ADD CGST @ 9.0% on Total Bill Rupees                                                49.50
                                                                                                                      49.50
ADD SGST @ 9.0% on Total Bill Rupees
                                                                                                                    649.00
GROSS TOTAL

Please issue cheque for the above said amount in the favour of Mr. VIKRANT GUPTA to be
drawn on CANARA BANK, A/C No. 2592101002205, Model Town Branch, IFSC Code:
CNRB0002592.

---PAGE END---