RAKESH KUMAR
                                                    SURVEYOR & LOSS ASSESSOR
 FLAT NO. 417, C-1, Muskan Appartment, Sector-17, Rohini, New Delhi-89
                                         Mob.#9868110525/8836301125
                                         E-mail: majokarakesh61197@gmail.com
                                         License No. SLA-61197,Valid upto 07/10/2023
                                         Pan No.AHEPK2434R/GST No.07AHEPK2434R2ZZ
 Ref:- BAJAJ/FINAL/2020/21/0451                                                                     Dated: 30/12/2020
                                                    HSN/SAC CODE:997162
 Bajaj Allianz General Insurance Company Limited.
Block No.4, 7th Floor, DLF Tower-15, Shivaji Marg, 011-66278225, New Delhi-110001.
 GST Number:07AABCB5730GIZZ
 VEHICLE NO.                 :       UP 17S 1485
 INSURED NAME           :        ARIF KHAN
CLAIM NO.                     :        OC-21-1103-1826-00001226
POLICY No.                               OG-20-2406-1826-00011012
ASSESSED LOSS              :       Rs. 7000/-


Professional
Professional Fee                                                                                                                                   550.00
Visit to workshop                           Roini To Ami Nagar,BPT, UP 136*4                                                   544.00
RE-Inspection Charges                                                                                                                             0.00
Under repair                                                                                                                                             0.00
In-Person verification Fee                                                                                                                         0.00
TOTAL                                                                                                                                              1094.00
CGST@9%:                                                                                                                                               98.46
SGST@9%                                                                                                                                                98.46
GROUND TOTAL                                                                                                                            1290.92


Thanks & Regards
Rakesh Kumar
Surveyors & Loss Assessors.

(Authorizea$natory g

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