ANUJ KUMAR AGARWAL
                                                                        Surveyor & Loss Assessor                       Tel. 01342-262305
                                                                 License No. SLA 25892, Exp. 09.11.22                 Mob.9412215972
                                                           Fellow Member , Dep. Motor, Marine & Engg.          Email a_bijnor@yahoo.com
                                                                                                                                        Add. H.N. 360, State Bank Colony
                                                                                                                                        Nai Basti, Bijnor-246701

                                                                                Survey Fee Bill
To,
      Bajaj Allianz General Insurance Co. Ltd.                                                           Bill. No : B-12/20/00786
      LUCKNOW                                                                                                         Date   23/12/2020
       4TH FLOOR HABIBULAH ESTATE ,HALWASIA BUILDING HAZARAT GANJ          Code   :
      LUCKNOW
      GSTIN: 09AABCB5730G1ZV               State Code : UP (09)
                  Report Ref No                      AK/BAGI/CS-3963/12-20/F/03185
                  Vehicle No.                           UP15CS 3963
                  Insured Name               :    VAIBHAV BAJAJ
                  Date Of Accident                 11/11/2020
                  Policy/cover note no     :    OG-21-1104-1802-00003986
                  Claim No                       :    OC-21-1301-1802-00001498

   S No                                         Particulars                                                  HSN/SAC                                 Amount 
      1     Final                                                                                                    997162                                       1,450.00
                     Professional Fee :       Assessed Amount & -100.00                                              750.00
                     Photos/CD Expenses :                                                                                               0.00
                      0 Photographs , Charged for 0 @ Rs. 10.00
                     Conveyance Expenses :                                                                                         700.00

      2                 D.A. 1/2 day                                                                               997162                                          175.00
                                                                                                                                          Sub Total :              1,625.00
                                                                                                                                      C GST @ 9.00 %                146.25
                                                                                                                                      S GST @ 9.00 %                146.25
                                                                                                                                       Grand Total :              1,917.50
                                                                                                                                          Round off :              1,918.00
                                                   In words : Rs. One Thousand Nine Hundred Eighteen Only
   GSTIN: 09 ADGPA7680K1Z8 State : (09)
   PAN. : ADGPA7680K
                                                                                                             HNSAN

   Bank Name : STATE BANK OF INDIA
                                                                                                             3   BURVEYOR
   A/c No.             31013997566
                                                                                                                    SLADEOO
   MICR No          : 264002303                                                       ANUJ KUMAR AGARWAL

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