Vivek M.Desai
                                                Surveyor  Loss Assessor.(Motor)
Licence No.: S.L.A.73760                                                                              Address:          29, Anand Nager Society, Morabhagal,
Valid upto: 03rd Oct.2021.                                                                                                              Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                                (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                               SURVEYFEEBILL
                                                                                     TAX INVOICE
To,                                                              BILL NO.                  2380-03-2020-21
Bajaj Allianz General Insurance Co.Ltd.(Regional Offic DATE                      26-03-2021
4th Floor, Atlantis Heritage,
Opp-Swagat Petrol Pump,                                      Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
Sarabhai Road, Vadodara -390007                        Office Code
           GSTIN No.24AABCB5730G1Z3         Claim No                  OC-21-2203-1870-00000697
REPORT NO               VD/BAGIC/03/2021/2380                                                                 DATE OF LOSS          5-Feb-2021
INSURED                 GIRDHARI SUKHDEV                                                                     DATE OF SURVEY       8-Feb-2021
POLICY NO.               OG-21-2203-1870-00001811
VEHICLE REGN. NO.      GJ05 RF 8742                    MAKE                     M SWIFT                   PLACE OF SUPPLY            GUJARAT
ESTIMATED LOSS       Rs.1,35,000                        ASSESSED LOSS                       66.468.00    STATE OF SUPPLY            GUJARAT
DESCRIPTION                                                           NO./KM                   RATE                 AMOUNT
01.PROFESSIONAL FEES:                                                                                                        Rs.        1,500.00
SPOT SURVEY
FINAL SURVEY                                                                                                        Rs.        1,500.00
RE-INSPECTION
02.EXPENSES                                                                                                                              Rs.           350.00
PHOTOGRAPH                                                                           Rs.                         Rs.
CONVEYANCE CHARGES                                                            Rs.              350.00  Rs.          350.00
HALTING ALLOWANCE                                                                                             Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                   Rs.
OUTSTATION TRAVELLING EXPENSES                                                                     Rs.
                  FROM
                       TO                                                                     Rs.                        Rs.
03.TOTAL FEES:                                                                                                                           Rs.        1,850.00
                                                                             CGST                      @                        9%            Rs.           166.50
  HSN/SAC CODE
                                TAXES (00440169)             SGST                      @                        9%            Rs.           166.50
        997162                                                         IGST                      @                                          Rs.
TOTAL:                                                                                                                                                Rs.        2,183.00
TOTAL AMOUNT WITH TAX:                                                                                                            Rs.2,183.00
                                                                                      Rupeess Two Thousand One Hundred Eighty Three Only
  HSN/SAC CODE                 997162
                       CENTRAL TAX                                           STATE TAX                                   INTERSTATE TAX
         RATE                       AMOUNT                      RATE                 AMOUNT                 RATE                  AMOUNT
           9%                          166.50                          9%                     166.50
  TAXABLE VALUE   Rs.                    1,850.00
   TOTAL TAX RS.     Rs.                      333.00

             GSTIN No.: 24AJAPD3623K1ZN
               PAN No.: AJAPD3623K
E &OE PRE RECEIPTED                                                      SURAT                                    V.M.Desai
                                                                                               6

                                                                                                                              VIVEK M DESAI
                                                                                                                             Surveyor & Loss Assessor.
* Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No:73760,Valid Upto:03/10/2021.

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