SAURABH JUNEJA
                                                        SURVEYOR & LOSS ASSESSOR
License No. : SLA 73349
                                                                                                               Mobile No. :9899 474 475
Valid Up to: 08-04-2023                                                                   E-Mail          : srbh.juneja@gmail.com
111SLA No. : A/N/5997                                                                      Phone(s)        011 -42058194

                                                                              Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                         Bill.No : B-01/21/04650
      Block No-4, 7 Th Floor DLF Tower Shivaji Marg New Delhi-110015                 Date : 16/01/2021
       New Delhi-110015                                                                                        Code
       GSTIN:07AABCB5730G1ZZ               State Code : Delhi (07)
                   Report Ref No                     SJ/BAGI/SBT3149/01-21/F/13081
                  Vehicle No.                         DL5SBT3149
                  Insured Name                     MR MANOJ KUMAR
                   Date Of Accident           :    24/12/2020
                   Policy/cover note no     :    OG-21-1103-1871-00000358
                   Claim No                      :    OC-21-1101-1871-00000361

    SNo                                       Particulars                                                HSN/SAC                               Amount 
       1    Final                                                                                               997162                                        650.00
                      Professional Fee :       Assessed Amount  6,502.00                                           500.00
                      Photos/CD Expenses :                                                                                          0.00
                      0 Photographs , Charged for 0 @ Rs. 0.00
                      Conveyance Expenses :                                                                                    150.00

       2                Re-Inspection                                                                        997162                                        150.00
                                                                                                                                     Sub Total :                800.00
                                                                                                                                C GST @ 9.00 %                 72.00
                                                                                                                                S GST @ 9.00 %                  72.00
                ADVANCE RECEIPT                                                                                 Grand Total :                944.00
                                                                                                                                    Round off :                944.00
                                                            In words : Rs. Nine Hundred Forty/Four Only
   GSTIN: 07AHGPJ3702K1ZG State : (07)
                                                                                                                        T
    PAN.:AHGPJ3702K
   Bank Name: AXIS BANK
   A/c No.             913020019916326
                                                                                                    SAURABH JUNEJA
   MICR No          110211039

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