Licence No. SLA/120614                                                                                                    Mobile No. : 9782773649
Valid upto 10th May 2021                                                                                                                       9799730029
                                                                                                                                     dipu.dilip2@gmail.com
Surveyor & Loss Assessore of Motor                                                                     DILIP KUMAR PRAJAPAT
& Marin Cargo                                                                                                            SURVEYOR & LOSS ASSESSOR
GSTIN-                                                                                                                                           154,Rabari Vas,
Reference N DKP/BGiC/01/2021/924                                                                                            Amii Road,Pindwara
                                                                                                                                    Dist.Sirohi,Rajasthan-307022
                                                                   BILL

Bill No. :    924
                                                                                         Mis. : Bajaj Ailianz Generai insurance Co. Ltd
Date    :     03/02/2021                                                               2nd & 3rd floor, 4 Hathroi Fort, Gopalbari,
                                                                                                  Ajmer Road, Jaipur-302001
                                                                                          GSTI:
Claim No.                 OC-21-1401-1801-00004695

Policy No                OG-21-3278-1801-00000182

Vehicle No.               RJ19CF3510
                                                                                          Date of Accident:           22/01/2021
insured Name           MR.MANISH KUMAR                                   Date of Survey 25/01/2021

                                                               PARTICULARS                                                                      AMOUNT

(a) Professional Fee                                                                                      Final                                    750.00

(b) Halting Allowance

 Conveyance (Local)                                                 Final & Re-Inspection                                             600.00
(d) Fare From           Sirohi To
    By Car
    Distance
(e)Speed Post=40                                                                                                                                      40.00

                                                                                                                                                             1,390.00
                                                                                                 Add  : CGST @ 9%
PAN No.CZJPK1227R                                                                  Add.: SGST @ 9%
                                                                                                 Add.: IGST @18%
                                                                                                                    Total                                 1,390.00
BANK -BANK OF BARODA
                                                                                                                                        UMAR
Address :- Shree Ji Plaza,Near Telephone Exchange,Pindwara-307022
A/c Name Mr. Dilip Kumar Prajapat A/c No. 55318100005070                                                Aity    H
IFS Code BARB0PINSIR Branch Code 307012027
                                                                                                                                                  lay  O
                                                                                                                                          SI
                                                                                                                        DILIP KUMARPRAJAPAT

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