RAKESH KUMAR
                                                        SURVEYOR & LOSS ASSESSOR
 FLAT NO. 417, C-1, Muskan Appartment, Sector-17, Rohini, New Delhi-89
                                            Mob.#9868110525/8836301125
                                           E-mail: majokarakesh61197@gmail.com
                                           License No. SLA-61197, Valid upto 07/10/2023
                                            Pan No.AHEPK2434R/GST No.07AHEPK2434R2ZZ
 Ref:- BAJAJ/FINAL/2020/21/0542                                                                        Dated: 12/02/2021

                                                        HSN/SAC CODE:997162
 Bajaj Allianz General Insurance Company Limited.
 Block No.4, 7th Floor. DLF Tower-15, Shivaji Marg, 011-66278225, New Delhi-110001.
 GST Number:07AABCB5730GIZZ
  VEHICLE NO.                  :        UP 14CF 8265
  INSURED NAME            :        AMIT KUMAR
 CLAIM NO.                      :        OC-21-1103-1802-00003377
 POLICY No.                       :        OG-21-1901-1802-00065312
 ASSESSED LOSS                        Rs. 7500/-


 Professional
 Professional Fee                                                                                                                                         400.00
 Visit to workshop                               Rohin To Modipuram, UP 190*4                                                         760.00
 RE-Inspection Charges                                                                                                                                   0.00
                                                                                    :
 Under repair                                                                                                                                                   0.00
 Spot verification Fee                                                                                                                                      0.00
 TOTAL                                                                                                                                                    1160.00
 CGST@9%:                                                                                                                                                   104.40
 SGST@9%                                                                                                                                                       104.4
 GROUND TOTAL                                                                                                                                 1368.80



 Thanks & Regards
 Rakesh Kumar

 Surveyors&             ssessors.
                                      TUMAR
                                                          mar

AuthorizeL
                                             ENA

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