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.:      20/03/786                                                                         Date: 7-Oct-20
To,
          M/S BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
                  BLOCK NO 603, 7TH FLOOR, 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. 2,006

Insurer                            BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.BLOCK NO 603, 7TH FLO
Policy No                        0G-20-2101-1826-00011100
Claim No                         OC-21-2101-1826-00000084
Policy Holder                  VISHAL GIRISH PAHUNE
Vehicle No                      MH49BL4073
Survey Dated                   5-0ct-20                                                                LOCATION :
Place of survey                SHRINIWAS MOTORS                                               WARDHA
Total Assessment             Rs.1,300
Remark

Particulars                                                       SAC CODE
Professional Fees FINAL                                          997162                        Rs              500
Photographs                                                          997162                        Rs                  0
                                                            160         997162                                         1200
Conveyance (To & Fro in Kms)                                                                    Rs
RE-INSPECTION                                                     997162                        Rs                  0
Spot Conveyance (To & Fro in Kms)                              997162                        Rs                  0
                                                                                            Total                     Rs. 1,700
Add CGST @ 9% (GST NO 27BQFPS9700K1ZC)                                                             Rs.153
Add SGST @ 9% (GST NO 27BQFPS9700K1ZC)                                                              Rs.153
Add IGST @ 18% (GST NO 27BQFPS9700K1ZC)                                                                     0
                                                                      Total Bill Amount                         Rs. 2,006
In words:

PAN No.                      BQFPS9700K
                                                                                                                    SAY
   GST NO               27BQFPS9700K1ZC
                                                                                                                    SLA
                                                                                                                   74708
SAC CODE                       997162
STATE
                                27 Maharashtra
CODE
                                                                                                              (Ali Imran Sayeed)

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