Pankaj Garg                                                         18, Surya Sushant Vihar, Goyal Vihar Road,
Survey & Loss Assessor                                                     Khajrana Ganesh Mandir, Indore 452016
(Motor & Engineering / Fellow )                                                Email : pankajopgarg@yahoo.com
IRDA/IND/SLA-56941/22/10/2022                                          Mobile No : 98270 34881, 97549 34882
                                                                                           Tax Invoice
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                           Bill. No : 05421
        4th Floor, Commerce House, 7 Race Course Road, Indore M.P.                                            Date:         07/01/2021
                                                                                                                                          Code    : Nil
       GSTIN:223AABCB5730G1Z5                     State Code: M.P. (23)
                    Report Ref No              :            BA/8626/20-21
                    Vehicle No.                                MH04JK8626
                    Insured Name              :            AMANDEEP SINGH
                    Date of accident           :           27/11/2020
                    Policy/cover note no     :            OG2119051803-2137
                    Claim No                     :           OC2123021803-115

     S No                                               Particulars                                                         HSN/SAC                                      Amount F
       1     Final                                                                                                              997162                                              2,900.00
                       Professional Fee :             Assessed Amount F 135,000.00                                                    2,500.00
                       Photos/CD Expenses :                                                                                                           50.00
                        CD with digital photographs
                       Conveyance Expenses :                                                                                                        350.00

       2     Relnspection                                                                                                 997162                                              1,200.00
                       Professional Fee :                                                                                                                850.00
                       Photos/CD Expenses :                                                                                                             0.00
                        0 Photographs , Charged for 0 @ Rs. 15.00
                       Conveyance Expenses :                                                                                                        350.00

                                                                                                                                                        Sub Total : F                 4,100.00
                                                                                                                                                    C GST @ 9.00 %                    369.00
                                                                                                                                                     S GST @ 9.00 %                    369.00
                 ADVANCE RECEIPT                                                                                                       Grand Total : F                 4,838.00
                                                                                                                                                        Round off : F                 4,838.00
                                                             In words : Rs. Four Thousand Eight Hundred Thirty Eight Only
   GSTIN: 23ACHPG3536G1ZZ State : (23)
   PAN. : ACHPG3536G
   Bank Name: Central Bank Of India
   A/c No.                : 1580809589
   MICR No       : 452016006                                                                                              (PANKAJ GARG)
   IFS Code       : CBIN0281097

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