Pankaj Garg
                                                                                                           18, Surya Sushant Vihar, Goyal Vihar Road,
         Survey & Loss Assessor                                                                   Khajrana Ganesh Mandir, Indore 452016
         (Motor & Engineering / Fellow )                                                                   Email : pankajopgarg@yahoo.com
         IRDA/IND/SLA-56941/22/10/2022                                                                   Mobile No : 98270 34881, 97549 34882
                                                                                                               Tax Invoice
         To,
                 Bajaj Allianz General Insurance Co. Ltd.                                                                                                          Bill. No : 05413
                 4th Floor, Commerce House, 7 Race Course Road, Indore M.P.                                                                                         Date:              31/12/2020
                                                                                                                                                                    Code         : Nil
                 GSTIN:2        23AABCB5730G1Z5                                         State Code           : M.P. (23)
                               Report Ref No                                         BA/7818/20-21
                               Vehicle No.                                           MP04GA7818
                                Insured Name                          :              DURGESH RATHORE
                               Date of accident                       :              07/11/2020
                                Policy/cover note no                  :              OG2014011803-6522
                                Claim No                                             OC2123021803-97
              S No                                                         Particulars                                                                      HSN/SAC                                                    Amount F
                1         Final                                                                                                                               997162                                                         1,800.00
                                   Professional Fee :                         Assessed Amount F 25,000.00                                                                                1,000.00
                                   Photos/CD Expenses :                                                                                                                                       50.00
                                    CD with digital photographs
                                   Conveyance Expenses :                       Visited total 100 Kms. No of visits 1 charged @F7.50/ Km                                                     750.00
                2         Relnspection                                                                                                                        997162                                                         1,200.00
                                   Professional Fee :                                                                                                                                       850.00
                                   Photos/CD Expenses :                                                                                                                                         0.00
                                    0 Photographs , Charged for 0 @ Rs. 15.00
                                   Conveyance Expenses :                                                                                                                                    350.00
                                                                                                                                                                                   Sub Total : F                             3,000.00
                                                                                                                                                                               C GST @ 9.00 %                                   270.00
                                                                                                                                                                               S GST @ 9.00 %                                   270.00
                            ADVANCE RECEIPT                                                                                                                                     Grand Total : F                              3,540.00
                                                                                                                                                                                   Round off : F                             3,540.00
                                                                                   In words : Rs. Three Thousand Five Hundred Forty Only
            GSTIN: 23ACHPG3536G1ZZ State : (23)
            PAN. : ACHPG3536G
            Bank Name         : Central Bank Of India
            A/c No.                        : 1580809589
            MICR No                : 452016006                                                                                                                  (PANKAJ GARG)
            IFS Code               : CBIN0281097
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