PARESH KOTHARI
                                          Approved Consulting Automobile and Engineering Surveyor, Loss Assessor & Valuer
S.L. NO.SLA -66761                                                                                                                      2C SONAL APRTMENT,
Dt. Exp. : 29-11-2021                                                                                                                   2 MARUTINAGAR,
Mobile :9825072771                                                                                                                   NEAR AIRPORT, RAJKOT -360001
pareshkothari1@gmail.com
                                                                               Survey Fee Bill
To,
       Bajaj Allianz General Insurance Co. Ltd.                                                          Bill. No : B-02-21-04313
       VADODARA                                                                                                     Date: 23/02/2021
       4O1,ATLANTIS HERITAGE,OPP.SWAGAT PETROL PUMP,SARABHAI MAIN     Code
       ROAD, NEAR GENDA CIRCLE
       GSTIN:24AABCB5730G1Z3               State Code : Gujarat (24)
                  Report Ref No                     VKP/BAGI/-T-9880/01-21/F/04321
                  Vehicle No.                    :    GJ 36 T 9880
                  Insured Name                     Ravibhai P Khambhala
                   Date Of Accident           :    18-Jan-21
                  Policy/cover note no           OG-21-2221-1803-00000179
                  Claim No                       :    OC-21-2204-1803-00000410

   S No                                        Particulars                                                 HSN/SAC                                Amount 
      1    Final                                                                                                  997162                                      1,800.00
                     Professional Fee :       Assessed Amount  95,000:00                                      1,500.00
                     Photos/CD Expenses :                                                                                          50.00
                      1 Photographs , Charged for 1 @ Rs. 50.00
                     Conveyance Expenses :                                                                                       250.00

                                                                                                                                       Sub Total : %            1,800.00
                                                                                                                                   C GST @ 9.00 %                162.00
                                                                                                                                   S GST @ 9.00 %                162.00
               ADVANCE RECEIPT                                                                                    Grand Total :            2,124.00
                                                                                                                                      Round off :            2,124.00
                                               In words : Rs. Two Thousand One Hundred Twenty Four Only
  GSTIN: 24ADNPK4533G1ZM State : (24)                                                                      Advance Receipt
  PAN.ADNPK4533G                                                                                                     Paresh Kothari
                                                                                                            PARESH KOTHARI'
  Bank Name : Bank of Baroda
                                                                                                                                                         M
  A/c No.            7460100005184
                                                                                                                                        Surveyokand Assessor
  MICR No           360012006

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