Lic.no.: 26815/Exp.28.01.2023         B.K.Gupta       Surveyor. Loss Assessor & Valuer
                                           2-Ka-15,Dadabari,Kota-9
Phone : 94141-88998                                           E-mail : bkgsuryey@yahoo.co.in
GSTI No. : 08ABYPG9645A1ZA                                              PAN No.: ABYPG 9645 A
Bajaj Allianz Generali Insurance Co. Ltd. (Raj.) GSTI No. : 08AABCB5730G1ZX
Bill no.Baj-86                                                                             Date : 26.10.2020
Issued to,
M/s Bajaj Allianz General Insurance Co. Ltd.
A/c: Mr.Rinku Sahu
Reg.: Final Survey of Vehicle no. RJ-20-EG-0049
Policy/C.note no./Period : OG-20-1401-1803-00000453 / 12.06.2020 to 11.06.2021
Claim no.: OC-21-1401-1803-00000275                         S/Allott.Date :19.09.2020
Date of Loss : 18.09.2020                                              S/Rep.no.: Bajaj/MT/20-21/86
                                                                                                      Rs.         500.00
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.
                                                                                                                    850.00
                                                                       CGST    9.00%         Rs.          76.50
                                                                        SGST    9.00%         Rs.          76.50
                                                                                Total              Rs.       1003.00
(Rupees One Thousand Three Only)
                                                                                           B.K.GUPTA

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