HEMANT R.PANCHAL
                                      Surveyor &Loss Assesor
            A-203,2nd floor,Rushi ComplexBeside Hari Om Petrol PumpLP.Savani Road
                                Adajan, Surat -394510. Mobile:98244 -75769.
                                     Lic.No.58125 Valid upto 30/01/2023.
                                              SURVEY BILL
To,
Bajaj AlianzGen.Ins.Co.Ltd
Gujarat
GST No.24AABCB5730G1Z3

[Bill / Ref. No.:                           HP/073/136/2020            Date:                  30/07/2020
Policy No                                OG-20-2203-1803-00005510
laim No.                                OC-21-2203-1803-00000057
Insured                                  [Jigar K. Patel
Vehicle no.                                [CJ05/YY/1488
                                                                                                  Amount
                                                                                                   Rs. Rs.
01.Survey Fees                                                                                        5,000

02.Out Station Allowance

03.TravelingConveyance charges                                                                   450

04.Photographs Charges                                                                                  40
05.Other Exps.
                                                                                                          5,490
AddGST                                   CGST                    09%                         494
GST No.24AIWPP4714A1ZA           SGST                    09%                         494
PAN no.AIWPP4714A                   IGST                     00%
                                                ADVANCE RECEIPT   Total Rs.                6,478
                                                                                                          EPANCH

                                                                     HEMANTRPANCHAL

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