HEMANT R.PANCHAL
                                   Surveyor &Loss Assesor
            A-203.2nd floorRushi ComplexBesidc Hari Om Petrol Pump.LP.Savani Road
                              Adajan, Surat -394510. Mobile98244-75769.
                                   Lic.No.58125 Valid upto 30/01/2023.
                                           SURVEY BILL
To,
Bajaj Alian GenIns. Co.Ltd
Gujarat
GST No.24AABCB5730G1Z3

[Bill/Ref.No.:                          HP/025/036/2020           [Date:                  08/06/2020
Policy No                              0G-20-2250-1801-00001080
[Claim No.                              OC-20-2203-1801-00000144
Insured                               [Niraj R.Desai
Vehicie no.                              [GJ05/IC/4896
                                                                                             Amount
                                                                                             Rs. Rs.
01.Survey Fees                                                                                     500

02.Out Station Allowance

03.Travelling&Conveyance charges                                                               300

04.Photographs Charges                                                                             40
05.Other Exps.
                                                                                                      840
AddGST                                 CGST                   09%                         76
GST No.24AIWPP4714A1ZA          SGST                   09%                        76
PAN no.AIWPP4714A                  IGST                    00%
                                             ADVANCE RECEIPT  Total Rs.                  991
                                                                          na             CHEMA
                                                                HEMANTPANCHAL            E

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