Er.KANHAIYA CHAUHAN
             Govt.Approved
SURVEYOR&LOSS ASSESSOR
INVESTIGATER,VALUER & CLAIM ADVISER
SPECIALIST IN MOTOR CLAIM'S
GST NO 09AENPC3685E1ZD
PAN NO.AENPC3685E
LICENCE NO.SLA-120150

BILL NO. MOTOR/FINAL/BAJAJ/464/20-21                                               DATE 28.02.2021

     INSURERS                                BAJAJ ALLIANZ GENERAL INSURANCE CO.Ltd.
     ADDRESS                                 THE SILVER LINE,11/9,,CIVIL LINES KANPUR
     INSURED                                   Mr Mayank Kumar Nagar        MODEL        Tata ACE Gold
     POLICY/COVER NOTE       :     OG-21-3327-1803-00000005     VEHICLE NO. UP 77 AN 7620
     CLAIM NO.                                OC-21-1301-1803-00001169
     DATE OF ACCIDENT                 24.02.2021                     DATE OF SURVEY 26.02.2021

                                                                                            Amount (Rs.)|Pa.
 1. Survey Fee                                                                           750        00
                                      covered 40 km From Panki to Madhana
2. Conveyance                                                                         300
                                               Kanpur& back @ 7.5/km                               00
 3.C D charges                                                                                        00
 4 Re-Inspection
 5S GST                            9% on the Gross Fee Amount             94.5
 6 CGST                             9%on the Gross Fee Amount               94.5
 7 Toll Tax
                                                                                 G Total      1239       00

 Rupee One Thousent Two Handred Threty nineonly.

     Cheque No :                                                                  Bank A/c No.20006890666
                                                                                            IFS code SBIN0000242
     Date:                                                                             Stae Bank of India

     E.&O.E.                                                                                      Kanhaiya Chauhan SLA-120150



                                                                                                                           SLA-120150
                                                                                                                        C

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