Vivek M.Desai
                                              Surveyor & Loss Assessor.(Motor)
Licence No.: S.L.A. 73760                                                                           Address:           29, Anand Nager Society,Morabhagal,
Valid upto: 03rd Oct.2021.                                                                                                          Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                             (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                            SURVEYFEEBILL
                                                                                 TAX INVOICE
To,                                                            BILL NO.                  2244-01-2020-21
Bajaj Allianz General Insurance Co.Ltd.(Regional OfficDATE                    26-01-2020
4th Floor, Atlantis Heritage
Opp-Swagat Petrol Pump,                                    Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
Sarabhai Road, Vadodara -390007                        Office Code
           GSTIN No.24AABCB5730G1Z3        Claim No                 OC-21-2203-1802-00001088
REPORT NO              VD/BAGIC/01/2021/2244                                                              DATE OFLOSS          7-Jan-2021
INSURED                 BHAVESH D CHOVATIYA                                                              DATE OF SURVEY       9-Jan-2021
POLICY NO.              OG-21-1904-1802-00043049
VEHICLE REGN.NO.      GJ05 SC 7074                   MAKE                    H Shine                    PLACE OF SUPPLY           GUJARAT
ESTIMATED LOSS       Rs.13,000                          ASSESSED LOSS                       5.393.00    STATE OF SUPPLY           GUJARAT
DESCRIPTION                                                         NO.1KM                  RATE                AMOUNT
01.PROFESSIONALFEES:                                                                                                    Rs.          500.00
SPOT SURVEY
FINAL SURVEY                                                                                                    Rs.          500.00
RE-INSPECTION
02.EXPENSES                                                                                                                         Rs.          500.00
PHOTOGRAPH                                                                        Rs.                        Rs.
CONVEYANCE CHARGES                                          2             Rs.             250.00  Rs.          500.00
HALTING ALLOWANCE                                                                                         Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                Rs.
OUTSTATION TRAVELLING EXPENSES                                                                   Rs.
                  FROM
                      TO                                                                  Rs.                       Rs.
 03.TOTAL FEES:                                                                                                                     Rs.        1,000.00
                                                                          CGST                     @                       9%            Rs.            90.00
  HSN/SAC CODE
                               TAXES (00440169)            SGST                     @                       9%            Rs.            90.00
        997162                                                      IGST                      @                                         Rs.
TOTAL:                                                                                                                                           Rs.       1,180.00
 TOTAL AMOUNT WITH TAX:                                                                                                        Rs. 1,180.00
                                                                                             Rupeess One Thousand One Hundred Eighty Only
   HSN/SAC CODE                997162
                       CENTRAL TAX                                         STATE TAX                                  INTERSTATE TAX
          RATE                      AMOUNT                     RATE                AMOUNT                RATE                 AMOUNT
            9%                          90.00                          9%                     90.00
   TAXABLE VALUE   Rs.                   1,000.00
    TOTAL TAX RS.     Rs.                      180.00
             GSTIN No.:24AJAPD3623K1ZN                                       DESA
                PAN No.: AJAPD3623K
 E &OE PRE RECEIPTED                                                                             6                  V.m.Desai
                                                                               S                                                                            Q

                                                                                                                           VIVEKM DESAI
                                                                                                                           Surveyor & Loss Assessor.
 * Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No:73760,Valid Upto:03/10/2021.

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