PRADEEP SAHAI GOUR                                                                                   Mobile No. 9425136278
B.E(Mech) FIIISLA                                                                                                                SRI CHITRAGUPT BHAWAN
Surveyor & Loss assessor                                                                                                     Near Physical College
License No. SLA11931/valid up-to 5th jan 2021                                                                       SHIVPURI (M.P )- 473551
IIISLA Membership No. F/W/03684                                                                                         e mail - ps_gour@rediffmail com

                                                                                      Provisinal Inoice
To,
        Bajaj Allianz General Insurance Co. Ltd.                                                                          Bill. No : B-12/20/00781
        Indore Branch                                                                                                            Date     : 14/12/2020
       Commerce House ,7 race coarse road, Indore (MP)                                                          Code     :
        GSTIN: 23AABCB5730G1Z5                      State Code:MP(23)
                    Report Ref No                     :     GOUR/BAGI/6ZZ7100/12-20/S/00870
                    Vehicle No.                        :     GJ06ZZ7100
                    Insured Name                    :     Mr Abdul Mohd.
                    Date Of Accident          :            10/12/2020
                    Policy/cover note no           :     OG-20-2225-1803-00002360
                    Claim No                           :

     S No                                              Particulars                                                        HSN/SAC                                     Amount Z
       1     Spot                                                                                                            997162                                             1,810.00
                       Professional Fee :                                                                                                              750.00
                       Photos/CD Expenses :                                                                                                        100.00
                        0 Photographs , Charged for 0 @ Rs. 10.00
                       Conveyance Expenses :      Visited total 120 Kms. No of visits 1 charged @28.00/ Km                                960.00

                                                                                                                                                      Sub Total : 2                1,810.00
                                                                                                                                                  C GST @ 9.00 %                   162.90
                                                                                                                                                 S GST @ 9.00 %                    162.90
                 ADVANCE RECEIPT                                                                                                    Grand Total : %                2,135.80
                                                                                                                                                      Round off :                 2,136.00
                                                               In words : Rs. Two Thousand One Hundred Thirty Six Only
   GSTIN: 23ABFPG3906K1ZW State : ()
   PAN. : ABFPG3906K
   Bank Name: HDFC Bank Ltd
   A/c No.                : 09071930000718
   MICR No              : 473240051
                                                                                                                                                       PRADEEP SAHAI GOUR
   IFS Code             : HDFC0000907

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