K.P.S. Chauhan                                                                                  152, Y-1, Kidwai Nagar, Kanpur - 208011
Surveyor & Loss Assessor                                                                                                 Mobile - 9415125675, 7007148588
License No. SLA 4265                                                                                                Email - kps_chauhan2002@yahoo.com
Valid Up to 23.11.2020                                                                                                              kps.chauhan2002@gmail.com
                                                                                         Tax Invoice
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                                         Bill. No : 0128/BAJAJ/20-21
       D.O. Kanpur                                                                                                              Date     : 228/09/2020
                                                                                                                                      Code     :
       GSTIN:                                                   State Code: (09)
                    Report Ref No                           KC/BAGI/5BD2589/09-20/F/00034
                    Vehicle No.                        :     UP25BD2589
                    Insured Name                    :    AMOL BHARDWAJ
                    Date Of Accident         :           8/17/2020
                    Policy/cover note no           :    OG-20-1307-1801-00000466
                   Claim No                           :    OC-20-1302-1801-00000996
    S No                                             Particulars                                                        HSN/SAC                                     Amount Z
       1     Final                                                                                                           997162                                            1,900.00
                       Professional Fee :             Assessed Amount  95,000.00                                                    1,500.00
                      Photos/CD Expenses :                                                                                                        50.00
                       0 Photographs , Charged for 0 @ Rs. 0.00
                       Conveyance Expenses :                                                                                                     350.00

                                                                                                                                                    Sub Total : %                1,900.00
                                                                                                                                                C GST @ 9.00 %                   171.00
                                                                                                                                                S GST @ 9.00 %                    171.00
                 ADVANCE RECEIPT                                                                                                   Grand Total : %                2,242.00
                                                                                                                                                    Round off :                 2,242.00
                                                             In words : Rs. Two Thousand Two Hundred Forty Two Only
   GSTIN: 09ABCPC3414F1Z9 State : (09)
   PAN. : ABCPC3414F
   Bank Name:
   A/c No.                :
   MICR No                                                                                                                                                         K.P.S. Chauhan
                             :

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