B.K. Gupta       Surveyor, Loss Assessor & Valuer
Lic.no.: 26815/Exp. 28.01.2023
                                          2-Ka-15, Dadabari, Kota-9
Phone :94141-88998                                          E-mail : bkgsurvey@yahoo.co.in
GSTI No. : 08ABYPG9645A1ZA                                            PAN No.: ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no. Baj-181                                                                          Date : 23.02.2021
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c : Mr. Vishnu Prasad
Reg.: Final Survey of Vehicle no. RJ-20-CC-2400
Policy/C.note no./Period : OG-21-1401-1801-00010464 / 13.12.2020 to 12.012.2021
Claim no.:OC-21-1401-1801-00005013                        S/Allott. Date : 10.02.2021
Date of Loss : 10.02.2021                                             S/Rep.no.: Bajaj/MT/20-21/181
                                                                                                    Rs.        750.00
2. Photographs CD                                                                        Rs.           0.00
3. Local Conveyence                                                                     Rs.        350.00
4.Out station Expanses :                                                                 Rs.

5. Haulting Allownce:                                                                     Rs.
6.Other Expanses                                                                          Rs.
                                                                                                                1100.00
                                                                      CGST    9.00%         Rs.          99.00
                                                                      SGST    9.00%         Rs.          99.00
                                                                              Total              Rs.       1298.00
(Rupees One Thousand Two Hundred Ninty Eight Only).

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