Lic.no.: 26815/Exp. 28.01.2023         B.K.Gupta       Surveyor., Loss Assessor & Valuer
                                           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-216                                                                          Date : 26.03.2021
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c : Mr. Mohd Shamim Ansari
Reg.: Final Survey of Vehicle no. DL-8S-CE-6516
Policy/C.note no./Period : OG-21-1401-1802-00090254 / 19.12.2020 to 18.12.2021
Claim no. : OC-21-1401-1802-00001454                        S/Allott. Date : 20.03.2021
Date of Loss : 20.03.2021                                             S/Rep.no.: Bajaj/MT/20-21/216
                                                                                                     Rs.         500.00
2. Photographs CD                                                                         Rs.            0.00
3.Local Conveyence                                                                     Rs.         350.00
4.Out station Expanses :                                                                  Rs.

5.Haulting Allownce:                                                                      Rs.
6.Other Expanses                                                                           Rs.
                                                                                                                   850.00
                                                                      CGST    9.00%        Rs.          76.50
                                                                       SGST    9.00%         Rs.          76.50
                                                                               Total              Rs.       1003.00
(Rupees One Thousand Three Only)

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