YASH JAIN H.No.-19/190,Krishna Puri Mathiya, Engineer Bhaiyaji Wali Gali, Govt. approved Loss Assessor ALIGARH-202001 Surveyor. Lic No. 120431 yashjainsurveyor@gmail.com IIISLA L/N/09452 M.No. +91-8445355091 GSTIN-09BHJPJ5501J1Z9 Survey Fee Bill To, Bajaj Allianz General Insurance Co. Ltd. Bill No. : B-03-24-03738 Branch Office Date 29/03/2024 15/54, 2nd floor, Virendra Smrati Complex, Civil Lines, Kanpur 208001 Code :yashjain.exe@surveyor.com GSTIN: 09AABCB5730G1ZV State Code: Uttar Pradesh (09) Report Ref No YJ/BAGI/1DD9133/03-24/F/03778 Vehicle No. : UP81DD9133 Insured Name : MR. SANGEETA DEVI Date Of Accident : 28-Dec-23 Assessed : 16,513.00 Policy/cover note no : OG-24-1104-1826-00003952 Estimate : 22,095.00 Claim No : OC-24-1302-1826-00011515 IDV :2 81,726.00 S No Particulars HSN/SAC Amount 1 Final 997162 1,550.00 Professional Fee : Assessed Amount 16,513.00 850.00 Photos/CD Expenses : 0.00 0 Photographs , Charged for 0 @ Rs. 0.00 Conveyance Expenses : Visited total 70 Kms. No of visits 1 charged @210.00/ Km 700.00 Sub Total : 1,550.00 C GST @ 9.00 % 139.50 S GST @ 9.00 % 139.50 ADVANCE RECEIPT Grand Total: 1,829.00 Round off : 1,829.00 In words : Rs. One Thousand Eight Hundred Twenty Nine Only GSTIN: 09BHJPJ5501J1Z9 State : (09) PAN.BHJPJ5501J Bank Name:PUNJAB NATIONAL BANK LTD YASH JAIN A/c No. 2961000100261910 Surveyor & Loss Assessor MICR No 202024005 IFS Code :PUNB0296100 ---PAGE END---