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-164                                                                         Date : 05.02.2021
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c : MS G R Infraprojects Limited
Reg.: Final Survey of Vehicle no. RJ-27-GD-4085
Policy/C.note no./Period : OG-21-1404-1803-00001557 / 23.10.2020 to 31.08.2021
Claim no. : OC-21-1401-1803-00000445                       S/Allott. Date : 17.12.2020
Date of Loss : 05.12.2020                                            S/Rep.no.: Bajaj/MT/20-21/164
1. Professional Fee (Est./Assd.: - / --)                                               Rs.       5000.00
2.Photographs CD                                                                        Rs.           0.00
3. Local Conveyence [Final + K.Open + Reins.]                                  Rs.       1050.00
4. Out station Expanses :                                                                Rs.

5.Haulting Allownce:                                                                     Rs.
6.Other Expanses                                                                         Rs.
                                                                                                               6050.00
                                                                     CGST    9.00%        Rs.        544.50
                                                                     SGST    9.00%        Rs.         544.50
                                                                             Total              Rs.       7139.00
(Rupees Seven Thousand One Hundred Thirty Nine Only)

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