Vivek M. Desai
                                               Surveyor & Loss Assessor. (Motor)
Licence No.: S.L.A. 73760                                                                             Address:          29, Anand Nager Society,Morabhagal,
Valid upto: 03rd Oct.2021.                                                                                                             Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                               (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                              SURVEYFEEBILL
                                                                                    TAX INVOICE
To,                                                              BILL NO.                  2282-02-2020-21
Bajaj Allianz General Insurance Co.Ltd.(Regional OfficDATE                     22-02-2021
4th Floor, Atlantis Heritage
Opp-Swagat Petrol Pump,                                      Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
Sarabhai Road, Vadodara -390007                        Office Code
           GSTIN No. 24AABCB5730G1Z3         Claim No                  OC-21-2203-1801-00003789
REPORT NO               VD/BAGIC/02/2021/2282                                                                 DATE OF LOSS          22-Jan-2021
INSURED                 ABBAS SIKNDAR SHAH                                                                 DATE OF SURVEY       23-Jan-2021
POLICY NO.              OG-21-9910-1801-00063165
VEHICLE REGN. NO.      GJ05 JA 6429                    MAKE                     MEECO                   PLACE OF SUPPLY           GUJARAT
ESTIMATED LOSS       Rs.35,000                          ASSESSED LOSS                                        STATE OF SUPPLY           GUJARAT
DESCRIPTION                                                          NO./KM                   RATE                 AMOUNT
01.PROFESSIONAL FEES:                                                                                                       Rs.          750.00
SPOT SURVEY
FINAL SURVEY                                                                                                       Rs.           750.00
RE-INSPECTION
02.EXPENSES                                                                                                                            Rs.          350.00
PHOTOGRAPH                                                                          Rs.                        Rs.
CONVEYANCE CHARGES                                                           Rs.             350.00  Rs.           350.00
HALTING ALLOWANCE                                                                                            Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                  Rs.
OUTSTATION TRAVELLING EXPENSES                                                                     Rs.
                   FROM
                       TO                                                                    Rs.                        Rs.
 03.TOTAL FEES:                                                                                                                         Rs.        1,100.00
                                                                            CGST                     @                        9%            Rs.            99.00
   HSN/SAC CODE
                                TAXES (00440169)             SGST                     @                       9%            Rs.            99.00
        997162                                                        IGST                      @                                         Rs.
TOTAL:                                                                                                                                               Rs.        1,298.00
 TOTAL AMOUNT WITH TAX:                                                                                                           Rs.1,298.00
                                                                                       Rupeess One Thousand Two Hundred Ninety Eight Only
  HSN/SAC CODE                997162
                       CENTRAL TAX                                          STATE TAX                                   INTERSTATE TAX
          RATE                       AMOUNT                      RATE                 AMOUNT                RATE                 AMOUNT
            9%                          99.00                          9%                     99.00
   TAXABLE VALUE   Rs.                    1,100.00
    TOTAL TAX RS.     Rs.                      198.00

             GSTIN No.: 24AJAPD3623K1ZN                                M.
                                                                                   EK
               PAN No.: AJAPD3623K
E&OE PRE RECEIPTED
                                                                                                                                                                      Q
                                                                                                   R                         V.M.Oesci
                                                                                                                              VIVEK MDESAT
                                                                                                                             Surveyor & Loss Assessor.
 * Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No:73760,Valid Upto:03/10/2021.

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