Lic.no.: 26815/Exp. 28.01.2023        B.K. Gupta       Surveyor, Loss Assessor & Valuer
                                          2-Ka-15, Dadabari, Kota-9
Phone : 94141-88998                                          E-mail : bkgsurvey@yahoo.co.in
GSTI No. : 08ABYPG9645A1ZA                                            PAN No.: ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no.:  Baj-106                                                                         Date : 12.11.2020
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c : Mr.Mahaveer Meena
Reg.:Final Survey of Vehicle no. RJ-08-GA-3837
Policy/C.note no./Period : OG-21-1401-1803-00000221 /21.05.2020 to 20.05.2021
Claim no. :OC-21-1401-1803-00000364                        S/Allott. Date : 27.10.2020
Date of Loss : 27.10.2020                                            S/Rep.no.: Bajaj/MT/20-21/106
                                                                                                   Rs.        750.00
2.Photographs CD                                                                        Rs.           0.00
3. Local Conveyence                                                                    Rs.           0.00
4. Out station Expanses : From Kota to Vill. Dalelpura (Bundi)                 Rs.       2040.00
   Two visits [120X2=240 Kms. To & fro] @ 8.50/Km.
5. Haulting Allownce: Two visits 1/3X2=2/3 day                                   Rs.        233.00
6.Other Expanses                                                                          Rs.
                                                                                                               3023.00
                                                                     CGST    9.00%        Rs.        272.07
                                                                      SGST    9.00%         Rs.         272.07
                                                                             Total              Rs.       3567.14
(Rupees Three Thousand Five Hundred Sixty Seven Paisa fourteen Only)
                                                                                             B.K.GUPT

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