ViveR M. Desai
                                                Surveyor & Loss Assessor.(Motor)
Licence No.: S.L.A.73760                                                                              Address:          29, Anand Nager Society, Morabhagal,
Valid upto: 03rd Oct.2021.                                                                                                               Rander Road, Surat - 395005.
Licentiate Membership No :L/W/06452                                                                (M)9879666447 & E-Mail: desaivivek29@gmail.com

                                                               SURVEYFEEBILL

                                                                                      TAX INVOICE
To,                                                               BILL NO.                   2326-03-2020-21
Bajaj Allianz General Insurance Co. Ltd. (Regional Offic DATE                     09-03-2021
 4th Floor, Atlantis Heritage
 Opp-Swagat Petrol Pump,                                      Policy issuing office:     Bajaj Allianz General Insurance Co. Ltd. (Regional Office).
 Sarabhai Road,Vadodara -390007                        Office Code
           GSTIN No.24AABCB5730G1Z3         Claim No                  OC-21-2203-1871-00000200
REPORT NO               VD/BAGIC/03/2021/2326                                                                 DATE OF LOSS          2-Feb-2021
INSURED                 DALSUKHBHAI GOVINDBHAI PAVASIYA                                            DATE OF SURVEY        6-Feb-2021
POLICY NO.               OG-21-2203-1871-00003104
 VEHICLE REGN.NO.       GJ07 CQ 6013                   MAKE                     H SPLENDOR PLUS     PLACE OF SUPPLY            GUJARAT
ESTIMATED LOSS        Rs.9,000                            ASSESSED LOSS                                         STATE OF SUPPLY            GUJARAT
DESCRIPTION                                                           NO./KM                   RATE                 AMOUNT
01.PROFESSIONAL FEES:                                                                                                         Rs.          350.00
SPOT SURVEY
FINAL SURVEY                                                                                                         Rs.           350.00
RE-INSPECTION
02.EXPENSES                                                                                                                              Rs.           350.00
PHOTOGRAPH                                                                            Rs.                         Rs.
CONVEYANCE CHARGES                                                            Rs.              350.00  Rs.           350.00
HALTING ALLOWANCE                                                                                             Rs.
OUT OF POCKET EXPENSES (COURIER)                                                                  Rs.
 OUTSTATION TRAVELLING EXPENSES                                                                      Rs.
                   FROM
                       TO                                                                     Rs.                        Rs.
 03.TOTAL FEES:                                                                                                                           Rs.          700.00
                                                                              CGST                      @                        9%            Rs.            63.00
   HSNISAC CODE
                                 TAXES (00440169)             SGST                      @                        9%            Rs.            63.00
         997162                                                         IGST                       @                                          Rs.
 TOTAL:                                                                                                                                                 Rs.          826.00
 TOTAL AMOUNT WITH TAX:                                                                                                            Rs.     826.00
                                                                                                                   Rupeess Eight Hundred Twenty Six Only
   HSN/SAC CODE                 997162
                        CENTRAL TAX                                           STATE TAX                                    INTERSTATE TAX
           RATE                       AMOUNT                      RATE                 AMOUNT                 RATE                 AMOUNT
             9%                           63.00                           9%                      63.00
    TAXABLE VALUE   Rs.                       700.00
     TOTAL TAX RS.     Rs.                       126.00

              GSTIN No.:24AJAPD3623K1ZN
                                                                                            M.
                 PAN No.: AJAPD3623K
 E &OE PRE RECEIPTED
                                                                                                                                 V.M.Desa
                                                                                             60
                                                                                                                                 VIVEKMDESAI
                                                                                                                                 Surveyor & Loss Assessor.
  * Please quote my Ref. Number/Job No. while disbursement of the payment of this bill.                       Lic No: 73760,Valid Upto:03/10/2021.

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