Ali Imran Sayeed
                                                                                                      INSURANCE SURVEYOR & LOSS ASSESSOR IRDA
                                                                                                    LICENCE NO- SLA74708, VALID UPTO- 19.12.2022
                                                                                            Phone- +91 8888865478. Email-reachaliimran@gmail.com
Bill No.:       20/03/229                                                                                 Date: 27-Jun-20
To,
           M/S BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
                    BLOCK NO 603, 7TH FLO0R, SHRI RAM SHYAM TOWER,
                    KINGSWAY, SADAR, NEAR NIT BUILDING,
                    NAGPUR 440001 Phone No 0712-3052136
                    GSTIN Number : 27AABCB5730G1ZX

Subject :                 Kindly arrange to pay the survey fees for above bill no of                   Rs. 1,121

Insurer                              BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.BLOCK NO 603, 7TH FLO(
Policy No                           0G-21-2001-1802-00001139
Claim No                            0C-21-2101-1802-00000025
Policy Holder                    AKASH CHANDUJI BANDURKAR
Vehicle No                         MH10BW9590
Survey Dated                    25-Jun-20                                                                      LOCATION :
Place of survey                  R.K MOTORS                                                                  YAVATMAL
Total Assessment              Rs.7,500
Remark

Particulars                                                             SAC CODE
Professional Fees FINAL                                               997162                          Rs                750
Photographs                                                                997162                          Rs                    0
                                                                    1            997162                                               200
Conveyance (To & Fro in Kms)                                                                            Rs
RE-INSPECTION                                                           997162                          Rs                    0
Spot Conveyance (To & Fro in Kms)                                  997162                          Rs                    0
                                                                                                     Total                           Rs.950
Add CGST @ 9% (GST NO 27BQFPS9700K1ZC)                                                                      Rs.86
Add SGST @ 9% (GST NO 27BQFPS9700K1ZC)                                                                       Rs.86
Add IGST @ 18% (GST NO 27BQFPS9700K1ZC)                                                                             0
                                                                              Total Bill Amount                            Rs. 1,121
In words:

PAN No.                         BQFPS9700K

   GST NO                 27BQFPS9700K1ZC
                                                                                                                            A  SLA
                                                                                                                            4  74708
SAC CODE                          997162
STATE
                                    27 Maharashtra
CODE
                                                                                                                         (Ali Imran Sayeed)

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