MAHESH PRAIAPATI                                Contact No.:7574844245
SURVEYOR&LOSS ASSESSOR&VALUER                           22, Vaikunth Park Society, Nr. Ashruti Tenament,
Promoted By IRDAGovt.of India                                                                         Jitodia Road,Anand -388001
SLA NO. 85079 Valid up to 09.10.2022                        Email : mahesh.bagic@gmail.com

                                                   Bill Cum Advance Receipt
                                                                    Invoice No.       6
                                                                    Invoice Date     23.05.2020
Ins Comp.   BAJAJALLIANZ GENERALINS CO LTD                           GSTIN      24AABCB5730G1Z3
                  VADODARA                                  Nature of Loss : Own damage/repair/spot
Insured     MR.ASIFBHAI A LINGADIYA             Vehicle No.      GJ03AX5488
Clalim No.  OC-21-2204-1803-00000029                                     Policy No.[OG-21-2204-1803-00000187
   Sr.No.                DESCRIPTION                   QTY.         UNIT     RATE            Rs.Ps.
      01      Survey Fees -OD                                    1               Per            0                               0.00
      01      Survey Fees - Spot                                  1               Per          500                         500.00
      02       Re Inspection Fees                                  1               Per            0                               0.00
      03      Daily Allowance                                      1              Each           0                             0.00
      04      Locai Conveyance Charges                       1              Each           0                               0.00
                 Re Inspection visits                                 1              Each           0                               0.00
                 Outstation Conveyance Charges              90              Km          7.5                          675.00
      05      Photograph (CD) Charges                        1              Each           0                               0.00
      06      Other Expense / Toll Taxes                                                                                             0.00
                                                                    Sub Total                                                            1175.00
GSTIN        24APMPP3544B1Z2                        SGST @           9.00%                                            105.75
SACCODE   997162                                         CGST @           9.00%                                            105.75
                                                                    Grand Total                                                         1386.50
Rupees:One thousand three hundred eighty seven only.

E. and O.E.                                                                            Bank Details :
Subject to Anand Jurisdiction                                                 ICICI Bank - Anand (Gamdivad Branch-0256)
Pan No.::APMPP3544B                                                          Account No. : 000301531217
                                                            ESH
SAC CODE997162                                                                IFSC Code : ICIC0000256
                                                                 SURVEYOR
                                                                                           Account Type : Savings
                                                                  SLA-85079
                                                                ANAND0
MAHESH PRAJAPATI

---PAGE END---