MANOHAR ADHIKARI
                                                                          SURVEYOR & LOSS ASSESSOR

         Refrence No. BAJAJ/2020/173                                                                                                         DATE 06.11.2020
                                                                       MOTOR SURVEY FEE BILL
        To,                                                                                  BAJAJ
        ALLIANZ GIC LTD.
        GST No.07AABCB5730G1ZZ HSN Code 997162
       Block No-4, 7th Floor DLF Towers,15 Shivajji Marg Delhi 110015
                          SLA No.                                                                                                          73766
                          Valid up to                                                                                             05th Oct 2021
                          PANNo.                                                                                               AHRPA8488Q
                          GST No.                                                                                       07AHRPA8488Q1Z9
                          Bank Name                                                                                         ICICI Bank Ltd
                          Account No.                                                                                           000 701547418
                         IFCS Code                                                                                               ICIC0000007

                         CLAIM NO.                                                                                            1802-00001780
                         INSURED NAME                                                                         HARSHIT BADHANI
                        REGD. NO.                                                                                                   UK193159
                        POLICY NO.                                                                                           1802-00009187

                        PROFESSIONAL FEE                                                                                        1,000.00
                       CONVEYENCE                                                                                                       350.00
                       RE-INSPECTION                                                                                                   300.00
                       TOTAL                                                                                                                1,650.00
                       IGST @ 18 %                                                                                                           297.00
                      GRAND TOTAL                                                                                                  1,947.00
 In words :    One thousand nine hundred fourty seven only
                         HARAD
Manohar Adhikari
Surveyor/& Eoss Asessor
                     SLAA76S
                      CR&

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