PRAVIN M. MUSALE
                                                     Motor Surveyor, Loss Assessor and Valuer
                                                    License No. : SLA - 73064 Exp.Dt. 08-02-2022
                                                                604 / Rilletta E / Casa Rio Gold,
                                             Kalyan-Shil Road, Dombivali East, Maharashtra - 421204
                                                                       Mobile. : 9821681100

                                                                  Final Survey Fees Bill

BILL NO               : BA/F/035                                                                                       Date : 09/02/2021

INSURERS           : BAJAJ ALLIANZ GENERAL INSURANCE CO. LT Div./Branch : Mumbai
POLICY NO.          :
CLAIM NO.            : OC-21-1901-1828-00000393
INSURED              : SHAHANAZ IMTIYAZ KHAN
VEHICLE NO.        : MH 04 JY 9666
SURVEYED AT: SAI POINT AUTOMOBILES PVT.LTD.,MUMBRA On Dt. : 09/02/2021

Professional Fees                                                                                             Rs.              750.00
Photograph (at Rs. 10.00 x 0 Copy)                                                              Rs.                    0.00
Traveling Expenses                                                                                          Rs.                300.00
Holting Allowance                                                                                             Rs.
Out city Allowance                                                                                            Rs.
Total                                                                                                               Rs.             1,050.00
18.00% GST Rs. 1,050.00                                                                                Rs.             189.00
Net Total                  Rounded to Nearest Rupees :                                          Rs. :         1,239.00
RupeeS :ONE THOUSAND TWO HUNDRED THIRTY NINE ONLY

Service Tax No.       : GSTIN NO. - 27ALPPM7590M1Z3
PAN NO. :                     ALPPM7590M
                                                                                                                    PRAVIN M. MUSALE
Advance Receipt

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