PARESH KOTHARI
                                         Approved Consuiting Automobile and Engineering Surveyor, Loss Assessor & Valuer
S.L. NO. SLA -66761                                                                                                                2C SONAL APRTMENT,
Dt. Exp. : 29-11-2021                                                                                                              2 MARUTINAGAR,
Mobile 9825072771                                                                                                              NEAR AIRPORT,RAJKOT -360001
pareshkothari1@gmail.com
                                                                            Survey Fee Bill
To,
       Bajaj Ailianz General Insurance Co. Ltd.                                                       Bill. No : B-12-20-04197
       VADODARA                                                                                                 Date   : 28/12/2020
      4O1,ATLANTIS HERITAGE,OPP.SWAGAT PETROL PUMP,SARABHAI MAIN     Code   :
       ROAD, NEAR GENDA CIRCLE
      GSTIN: 24AABCB5730G1Z3              State Code : Gujarat (24)
                  Report Ref No                    VKP/BAGI/AX-6654/12-20/F/04251
                  Vehicle No.                   :    GJ 3 AX 6654
                  Insured Name              :    Ajitbhai I Ker
                  Date Of Accident                24-Nov-20
                  Policy/cover note no     :    OG-20-2204-1803-00004373
                  Claim No                     :   OC-21-2204-1803-00000310

   S No                                      Particulars                                              HSN/SAC                              Amount
      1    Final                                                                                             997162                                    2,800.00
                    Professional Fee :       Assessed Amount  140,000.00                                   2,500.00
                    Photos/CD Expenses :                                                                                      50.00
                     1 Photographs , Charged for 1 @ Rs. 50.00
                    Conveyance Expenses :                                                                                   250.00

                                                                                                                                  Sub Total:            2,800.00
                                                                                                                             C GST @ 9.00 %               252.00
                                                                                                                             S GST @ 9.00 %               252.00
              ADVANCE RECEIPT                                                                                Grand Total:            3,304.00
                                                                                                                                 Round off :            3,304.00
                                                 In words : Rs. Three Thousand Three Hundred Four Only
  GSTIN: 24ADNPK4533G1ZM State : (24)                                                                       Advance Receipt
   PAN. : ADNPK4533G                                                                                                    Paresh Kothari
                                                                                                        PARESH KOTHARI
   Bank Name : Bank of Baroda                                                                                                   Notuw
   A/c No.            7460100005184
  MICR No                                                                                                                      Surveyor and Assessor
                          360012006

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