DHAVAL SHAH.                                                  1                   GSTIN - 24BDUPS5607P1ZMPAN - BDUPS5607P
SURVEYOR         VALUER          LOSS ASSESSOR                                 LICENSE NO. - 74141 / 2019-2022
ADDRESS:-                                                                                                             BILL NO. :- 19115720
12/A, TIRTHBHOOMI APPT.,
NR. ASHOKNAGAR SOC.,
NAVA VIKAS GRUH ROAD, FATEHPURA,
PALDI, AHMEDABAD - 380 007.                                                                STATE OF SUPPLY -GUJARAT. (CODE - 24)


                                                       ADVANCE SURVEY FEE BILL

To,
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
4TH FLOOR, TORQUOISE,
NR. PANCHVATI CIRCLE,
C. G. ROAD, Ahmedabad - 380006
GSTIN NO.:- 24AABCB5730G1Z3

Policy No.           OG-20-2201-1803-00004056                                Invoice Date :-                 07-03-2020
Claim No. -          OC-20-2204-1803-00000400

Insured Name :- JAGJIVANBHAI                                                  VehiCle No. :- GJ6AV8924
Make & Model :- EICHER PRO 3015
                                                                         SAC CODE
Survey Fees. (FINAL )                                                9971                    Rs.                            500
Local Expenses. (2 VISIT )                                           9971                    Rs.                             0
Travelling Expenses. (A'BAD TO
LIMBADI 116 X 2 = 232 Kms. X 7.5                                9971                    Rs.                           1740
Rs.)
Incidental Expenses                                                  9971                    Rs.                             0
Photograph Expenses                                                9971                    Rs.                             0
Reinspection Fees                                                     9971                    Rs.                             0
SGST (@ 9% )                                                                                      Rs.                          201.6
CGST (@ 9% )                                                                                     Rs.                          201.6
                                          TOTAL                                                                                  2643.2

                                                                                                                                             AVAL
                                                                                                                                                 SLA

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