Yogesh Gupta
Surveyor&Loss Assessor
License No.     120998                                                  Office:                        SCF-10,Sector-6
Valid upto       20.01.2022                                                                    Bahadurgarh,Distt. Jhajjar
Deptt.            :Motor                                                                                        Haryana-124507
PAN No.         AIEPG3565C
                                                                                                                       M9728410038
Ref.No.YRK/Bajaj/20/Motor/094                                                                  September 5,2020
       Bajaj Allianz General Insurance Co.Ltd;
       Moti nagar
       Delhi.

                                         Policy No.      OG-20-1901-1802-00077795
                                          Claim No.      OC-21-1103-1802-00001258
                                       Vehilce No.      HR13M0663
                                Insured's Name      :KAJAL

                                                               SURVEY FEE BILL

 AProfessional Fee for Spot survey                                              :Rs.                       0.00
 B Professional Fee for Final survey                                              :Rs.                   550.00
        (Assessed loss amount Rs.)        10212.00
 c Professionai Fee for Re-inspection survey                                :Rs.                       0.00
        Conveyance Charges (Local)                    2                               :Rs.                   300.00
        Conveyance(Out Station)                         0            0                 :Rs.                       0.00
       Photographs-Digital                                 0            0                 :Rs.                       0.00
                                                                                                                                 850.00

                  Total Rs.850.00
        (Rs.EIGHT HUNDRED FIFTY ONLY.)
                          Gupta
                                   *
                     9LA   B
                    120996

        (Yogesh Gupta)
        Surveyor and Loss Assessor
        NEFT Details:
       Name:               YOGESH GUPTA
        Bank:               INDUSIND BANK
       A/cNo.            159728410038

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