Er. KANHAIYA CHAUHAN
             Govt.Approved
SURVEYOR& LOSS ASSESSOR
INVESTIGATER,VALUER & CLAIM ADVISER
SPECIALIST IN MOTOR CLAIM'S
GST NO 09AENPC3685E1ZD
PAN NO.AENPC3685E
LICENCE NO.SLA-120150

BILL NO. MOTOR/FINAL/BAJAJ/534/20-21                                               DATE 22.03.2021

    INSURERS                                BAJAJ ALLIANZ GENERAL INSURANCE CO. Ltd.
     ADDRESS                                THE SILVER LINE,11/9, CIVIL LINES KANPUR
     INSURED                                 Mr Rajeev Kumar                  MODEL          Bajaj Pulsar
     POLICY/COVER NOTE      :     OG-21-1302-1826-00020323    VEHICLE NO. UP78 GJ 5059
     CLAIM NO.                                OC-21-1302-1826-00003703
     DATE OF ACCIDENT                 17.03.2021                     DATE OF SURVEY 23.03.2021

                                                                                          Amount (Rs.)|Pa.

1. Survey Fee                                                                         500        00
                                       covered 80 km From Panki to Krishna
2. Conveyance              Motors Shivraj pur Kanpur & back @          600
                                                          7.5/km                                          00
3. C D charges                                                                                      00
 4 Re-Inspection
 5 S GST                           9% on the Gross Fee Amount              99
 6 C GST                            9%on the Gross Fee Amount                99
 7 Toll Tax
                                                                                G Total[     1298       00

Rupee one Thausent Two Handred Ninty eight only.

     Cheque No :                                                                 Bank A/c No.20006890666
                                                                                           IFS code SBIN0000242
     Date:                                                                            Stae Bank of India


     E.&O.E.                                                                                     Kanhaiya Chauhan SLA-120150

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