Final (Esti SL. No) + RI - For Nil Dep

R.
NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088

LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]
MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

Surveyor - Valuer - Automobile Engineer - Loss Assessor
Ref No: MV- Date :

MOTOR SURVEY REPORT - FINAL
This report is issued "Without Prejudice" in respect of cause, nature, extent of loss and damage subject to the
terms and conditions of insurance policy.
Policy No :
Period of Insurance :
Type of Policy : Private Car Package Policy - Nil Dep
Insured Declared Value :
Claim No :
1. INSURER :
2. INSURED :
3. FINANCIARS IF ANY :
4. VEHICLE PARTICULARS:-
a. Registration No :
b. Date of Registration & Year of Manufacturing :
c. Chassis No. : Physically Verified.
d. Engine No. :
e. Makers Name : M/S
f. Makers Classification :
g. Class of vehicle :
h. Type of body :
i. Type of fuel :
j. Cubic Capacity / Seating capacity :
k. Color of the vehicle :
l. G. V. W / Unladen weight / Carrying Capacity. :
m. Pre - Accident conditions : Fairly Maintained.
n. Tax Paid Details :
o. Fitness No & Validity : Valid Upto -
p. Permit No & Validity. :
HEAD OFFICE: BRANCH OFFICE:
Room No. 74, PG Mansion, Plot No.6, Preethi Nagar, Annanagar Extn.,
N. No. 8&10, Old No. 38 & 391 Palamarathupatti, Nagal Nagar (PO),
Maninagaram Main road, Madurai - 625 001 Dindigul - 624 003.
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
5. DRIVER PARTICULARS:-
a. Name :
b. Address of the driver. :
c. Driving License No. :

d. Date of Issue. :
e. Validity :
f. Type of License :
g. Transport Vehicle Badge No. :
h. Issuing Authority. :
6. VERIFIED DETAILS:-
a. Policy Copy : Yes (Photo Copy).
b. Registration Certificate : Yes (Photo Copy).
c. Permit. : Not Applicable.
e. Driving License : Yes (Photo Copy).
f. Police report Details. : Yes (Photo Copy).
g. Trip Sheet Details : Not Applicable.
7. ACCIDENT AND SURVEY DETAILS:-

a. Date and Time of Accident :
b. Place of Accident :
c. Place of Survey :
d. Date of request for Survey :
e. Date & Time of Survey :
F. Deputed by whom
8. POLICE REPORT DETAILS;-

a. Is the accident reported to Police :
b. Name of the Police station :
c. Station FIR No & Date :
d. Is there any third party involved in this accident :
e. Is there any third party sustained injury :

f. Action taken by the Police :
9. CAUSE AND NATURE OF ACCIDENT;-


Ref No: MV-RI- Date :
MOTOR SURVEY REPORT - RE-INSPECTION
Pursuant to the request from The ------------, Insurance co. Ltd,Madurai. I had been to M/S -------------- Madurai.and carried
out Re-Inspection on the following vehicle as having completed accident repair work. This report is issued without prejudice.
Policy No :
Period of Insurance :
Type of Policy : Private Car Package Policy - Nil Dep
Insured Declared Value :
1. INSURER :
0
0
2. INSURED :
0
0
3. VEHICLE PARTICULARS:-
a. Registration No :
b. Date of Registration & Year of Manufacturing :
c. Chassis No. : Physically Verified.
d. Engine No. :
e. Makers Name : M/S
f. Makers Classification :
g. Class of vehicle :
4. ACCIDENT AND SURVEY DETAILS:-
a. Date and Time of Accident :
b. Place of Accident :
c. Place of Survey :
d. Date of Deputed for Re-Inspection. :
e. Date & time of Survey :
F. Deputed by whom :
5.SPARES RECOMMENDED AND OPINION:-
1. Spares recommended at cost. : Replaced with new one.
2. Spares with 0% Depreciation for (Plastic Parts) : Replaced with new one.
3. Spares with 0% Depreciation for (Metal Parts) : Replaced with new one.
2. Labor recommended. : Carried out to the satisfaction.
Note:- 1. Entire salvage produced for my Inspection, 2. 16 No of photos taken by me is enclosed herewith.

Spot Survey
Spot Survey By : Mr. ------------------., Madurai.
Spot Survey report received on : 25.03.2017 by post
Extn.,
LICENSE NO: SLA - 17364 VALID 20/12/2020 Email ID: [email protected]
LOSS ASSESSMENT SHEET FOR : TN INSURED : MR.
SPARES WITH NIL DEPRECIATION ( PLASTIC PARTS ) UNDER 28% GST:-

Sl.No Description of Parts Damage Qty Est. No Estimated Billed Assessed Inv. Sl. No
1 1No. 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 0.00
Add GST @ 28% 0.00
Works out to 0.00
Add @25% of consolidated painting considered as Material Rs. 0.00 0.00
Add GST @18% for Painting Materials ( Incurred Expenses ) 0.00
Works out to 0.00
Less Depreciation @ 0% 0.00
SUB TOTAL 0.00
SPARES WITH NIL DEPRECIATION ( PLASTIC PARTS ) UNDER 18% GST:-

Sl. No Description of Parts Damage Qty Est. No Estimated Billed Assessed Inv. Sl. No
1 1No. 0.00
2 1No. 0.00
3 1No. 0.00
4 1No. 0.00
5 1No. 0.00
6 1No. 0.00
7 1No. 0.00
8 1No. 0.00
9 1No. 0.00
10 0.00
Total 0.00
Add GST @ 18% 0.00
Works out to 0.00
Less Depreciation @ 0% 0.00
SUB TOTAL 0.00
SPARES WITH NIL DEPRECIATION ( METAL PARTS ) UNDER 28% GST :-

1 1No. 0.00
2 0.00
Total 0.00
Add GST @ 28% 0.00
Works out to 0.00
Less depreciation @ 0% 0.00
SUB TOTAL 0.00
SPARES WITH NIL DEPRECIATION ( METAL PARTS ) UNDER 18% GST :-

1 1No. 0.00
2 0.00
Total 0.00
Add GST @ 18% 0.00
Works out to 0.00
Less depreciation @ 0% 0.00
SUB TOTAL 0.00
SPARES AT COST UNDER 18% GST :-

1 Front windshield glass 1No. 0.00
2 Door glass 1No. 0.00
Total 0.00
Add GST @ 18% 0.00
SUB TOTAL 0.00
LABOUR CHARGES:-
Sl. No Description of Labour R & R (A) Repair (B) Painting (C) A+B+C
1 0.00 0.00 0.00 0.00
2 0.00 0.00 0.00 0.00
3 0.00 0.00 0.00 0.00
4 0.00 0.00 0.00 0.00
5 0.00 0.00 0.00 0.00
6 0.00 0.00 0.00 0.00
7 0.00 0.00 0.00 0.00
8 0.00 0.00 0.00 0.00
9 0.00 0.00 0.00 0.00
10 0.00 0.00 0.00 0.00
11 0.00 0.00 0.00 0.00
12 0.00 0.00 0.00 0.00
13 0.00 0.00 0.00 0.00
14 0.00 0.00 0.00 0.00
15 0.00 0.00 0.00 0.00
16 0.00 0.00 0.00 0.00
Total 0.00 0.00 0.00 0.00
Less @ 25% consolidated painting considered as Material 0.00

Works out to 0.00
Add GST@ 18% on ( Labour ) 0.00
SUB TOTAL 0.00
SUMMARY OF ASSESSEMENT
Sl. No Description Spares & Labour Estimated Billed Assessed Allowable
1 Spares 0.00 0.00 0.00
2 Labour 0.00 0.00 0.00
3 Labour towards towing charges 0.00 0.00 0.00
Total 0.00 0.00 0.00
Less Salvage Value 0.00
Works out to 0.00
Less Policy excess 1000.00
Net liability to the Insurer. -1000.00
Note:
1 Survey work assigned by.
2 20 No of photos taken by me is enclosed herewith.
Spot Survey
Spot Survey By : Mr. ------------------., Madurai.
Spot Survey report received on : 25.03.2017 by post
Gross Assessed Loss Adjusted Loss

Plastic Parts 0.00 0.00
Metal Parts 0.00 0.00
Glass 0.00 0.00
Labor 0.00 0.00
To add Paint Not Applicable
0.00
Materials
Sub Total 0.00 0.00

( Before any Deduction ) Less Salvage 0.00
Less Excess 1000.00
NET Liable -1000.00

Ref No: MV- Date :
TO
The Branch Manager,

:
0
0
Sir
Final Survey report for the Vehicle Regn No. :

Insurer :
Insured :
Policy No: :
Date of Accident :
Pursuant to your request, I had been to M/S //////////////////////Madurai. and carried out survey work on the above
captioned vehicle, Please find the detailed final survey report as presented below.
(R. NATARAJAN)
Insurance Surveyor
Encl: 1. Final Survey report with 20 No of photos, 2. Repair Estimate, 3. Tax Invoice, 4. Claim Form, 5.Policy copy, 6. RC.,
7. DL., 8. Driver statement.


TO
The Branch Manager,
:
0
0
Sir
Re-Inspection Report for - :
Insurer :
Insured :
Policy No: :
Date of Accident :
Pursuant to your Instructions I had been to M/S K.V.V. Coach Builders, Kovilpappakudi, Madurai on ????? and carried
out Re-Inspection on the above captioned vehicle as having completed accident repair work. Please find the detailed Survey
Report as presented.
(R. NATARAJAN)
Insurance Surveyor

Room No. 74, PG Mansion, NO. 47/35-B-12, Kullanampatty,
N. No. 8&10, Old No. 38 & 391 Nagal Nagar (PO),


Ref No: MV- Date :
TO
The Branch Manager,
:
0
0
Sir
Final Survey report fees bill for the Vehicle Registration No. :
Insurer :
Insured :
Policy No::
Date of Accident :
SURVEY FEES BILL
As per the revised schedule w.e.f 01/04/2017
Professional Fees 850.00
0.70% on Balance Rs. -200000.00 -1400.00
Local Conveyance 350.00
Daily Allowance 500.00
Travelling Expenses 0.00
Photos Charges 200.00
Miscellaneous Charges 0.00
Total 500.00
Bank Details:
Account No : 352010100015288 - PAN NUMBER: AAWPN4166E
Bank Address : AXIS BANK, Salai road, Dindigul.
Account Type : Savings
IFSC Code : UTIB0000352 (R. NATARAJAN)
MICR Code : 624211002 Insurance Surveyor

Room No. 74, PG Mansion, Plot No.6, Preethi Nagar, A
N. No. 8&10, Old No. 38 & 391 Palamarathupatti, Nagal Na

TO
The Branch Manager,
:
0
0
Sir
Re-Inspection Survey fees bill for the Vehicle Registration :
Insurer :
Insured :
Policy No::
Date of Accident :
RE-INSPECTION SURVEY FEES BILL

As per the revised schedule w.e.f 01/04/2017
Professional Fees - If More than 80 Kms - 1200 850.00
Local Conveyance 350.00
Daily Allowance 0.00
Travelling Expenses 0.00
Photos Charges 200.00
Total 1400.00
Bank Details:
Account No : 352010100015288 - PAN NUMBER: AAWPN4166E
Bank Address : AXIS BANK, Salai road, Dindigul.
Account Type : Savings
IFSC Code : UTIB0000352 (R. NATARAJAN)
MICR Code : 624211002 Insurance Surveyor


Final (Esti SL. No) + RI - For Nil Dep

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R.

NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088

MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

Ref No: MV- Date :

c. Driving License No. :

7. ACCIDENT AND SURVEY DETAILS:-

8. POLICE REPORT DETAILS;-

e. Is there any third party sustained injury :

9. CAUSE AND NATURE OF ACCIDENT;-

MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

HEAD OFFICE: BRANCH OFFICE:

LOSS ASSESSMENT SHEET FOR : TN INSURED : MR.

SPARES WITH NIL DEPRECIATION ( PLASTIC PARTS ) UNDER 28% GST:-

SPARES WITH NIL DEPRECIATION ( PLASTIC PARTS ) UNDER 18% GST:-

SPARES WITH NIL DEPRECIATION ( METAL PARTS ) UNDER 28% GST :-

SPARES WITH NIL DEPRECIATION ( METAL PARTS ) UNDER 18% GST :-

SPARES AT COST UNDER 18% GST :-

Less @ 25% consolidated painting considered as Material 0.00

Gross Assessed Loss Adjusted Loss

Sub Total 0.00 0.00

MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

Ref No: MV- Date :

The Branch Manager,

Final Survey report for the Vehicle Regn No. :

HEAD OFFICE: BRANCH OFFICE:

MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

Ref No: MV-RI- Date :

HEAD OFFICE: BRANCH OFFICE:

Maninagaram Main road, Madurai - 625 001 Dindigul - 624 003.

MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

Ref No: MV- Date :

HEAD OFFICE: BRANCH OFFICE:

MOTOR - ENGG - FIRE - MARINE - MISC - (FELLOW MEMBER-F/S/06514)

Ref No: MV-RI- Date :

RE-INSPECTION SURVEY FEES BILL

HEAD OFFICE: BRANCH OFFICE:

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