Pre-receipted
                                                                                                            Survey fee bill
                                                          HARESH CHANDRA YADAV
                                                                                     SURVEYOR&LOSSASSESSOR
                      Licence No.:SLA 120840                                                                         Office-32d/123,Bhoor Ka Bagh,Shanti Nagar,Agra
                      Valid upto17 Oct 2021                                                                                                                                         Mobile No.8979314637
                      PAN:ACJPY5934 E
                      Ref.No.:2020-2021/517                                                                                                                                                                    23.01.2021
                      To
                                            The Manager
                                            Bajaj Allianz General Insurance Co.Ltd.
                                          15/54-B,2ND FLOOR,VIRENDRA SMRATI COMPLEX
                                            CIVIL LINES,KANPUR.208001
                                            GST No-09AABCB5730G1ZV
                                            Sir,
                                                          Re:Vehicle No                                                            CH.-330461
                                                                  Insured                                                          Mr.D.S.Sikarwar
                                                                   Date of Accident                                                02.01.2021
                                                                  Insurance Policy No.                                             OG-20-1201-1826-00000288
                                                                  Claim No.                                                        OC-21-1302-1825-00002394
                      1).                   Professional Fee                                                 Assed                2075/-
                                            A).Final                                                                                                                                              Rs.                  500.00
                      2).                    Conveyance                                 O/-Km One Side Of Car                                                                                     Rs.                   350.00
                      3).                 Toll tax                                      0/-Toll Tax(Both Side)                                                                                    Rs.                       0.00
                      4).                   Reinspection                                                                                                                                          Rs.                       0.00
                                                                                                                                                                         Total                    Rs.                   850.00
                                                                                                                                                       Add CGST 9%                                Rs.                       0.00
                                                                                                                                                       Add SGST 9%                                Rs.                       0.00
                                                                                                                                                               G.Total                            Rs.                   850.00
                                                                  Thanking you,
                                                                                                                                                                                                                    Falt
                                                                                                                                                                                                     2   SLA-120840
                                                                                                                                                                           {Haresh Chandra Yadavy
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