Rajesh S. Thakker C.A.E., D.A.E., A.I.S.A. SURVEYOR, LOSS ASSESSOR & VALUER Licence No. SLA 20725 Exp. Dt. 17-08-2021 5, PATEL COLONY, ROAD NO. 1, OPP. DARSHAN APARTMENT, JAMNAGAR - 361 008, (GUJARAT) MO. 98242 11549, 94274 45301 E-mail : rajesh_thakker@rediffmail.com Survey Fee Bill To, Bajaj Allianz General Insurance Co. Ltd. Bill. No : RST/203202 Rajkot Date : 29/12/2020 1st Floor, Hotel K Rose Building, In Front Of Shastri Medan, Limda Chowk, Code : Rajkkot GSTIN: 24AABCB5730G1Z3 State Code: Gujarat (24) Report Ref No : RST/203202 Vehicle No. : GJ10BL4228 Insured Name : Ram Boda Date of accident : 26-11-2020 Policy/cover note no : OG-21-1000-1802-00022623 Claim No : OC-21-2204-1802-00000802 S No Particulars HSN/SAC Amount / 1 Final 997162 1300.00 Professional Fee : Assessed Amount 754.00 350.00 Photos/CD Expenses : 50.00 CD with digital photographs Conveyance Expenses : Visited total 120 Kms. No of visits 1 charged @27.50/ Km 900.00 Sub Total : 2 1300.00 C GST @ 9.00 % 117.00 S GST @ 9.00 % 117.00 ADVANCE RECEIPT Grand Total : 2 1534.00 Round off : 1,534.00 In words : Rs. One Thousand Five Hundred Thirty Four Only GSTIN: 24AAUPT4514C1ZN State : (24) PAN. : AAUPT4514C 31n0Qa0 Bank Name : HDFC Bank Ltd., RAjesh s ThakKer C.A.E.,D.Ae.,A.II.S.A. A/c No. : 01771500003760 SURVEYCR &LCES ASSESSOR MICR No : 361240001 ---PAGE END---