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DETAILS OF ACCIDENT
a) Date & time of accident : 02-02-2017 at about 04:00 p.m.
b) Place of accident : Barnala road, Sirsa.
c) Date of allotment of Survey : 3/2/2017
0 Date & time of survey : 3/2/2017
e) Date of receipt of spot survey report : -
DETAIL OF LOAD CHALLAN : N.A.
VERIFICATION
a) Registration Certificate : Yes Found O.K
b) Driving Licence : Yes Found O.K
c) Route Permit : -
VEHICLE WILL BE SHIFTED TO/REPAIRED
: At M/s Telmos Automobiles, Pvt. Ltd., Sirsa.
AT
As stated & also reported in the enclosed claim form, the subject M-cycle was on its way, near the site of
accident, at the crossing chowk a TP Tata Ace Vehicle hit with frt side of insured m-cycle after which M-
cycle in question fell down and sustained damages.
Note :- Damages sustained to the vehicle were fresh in nature & attributed to cause & history of
accident as narrated by insured.
DETAILS OF LOSS/DAMAGE
Under valuable advices received from Insurer office on dt. 03-02-2017 in connection with the job relating
to survey of said vehicle I, the undersigned , visited the repairer workshop of M/s Telmos Automobiles,
Pvt. Ltd., Sirsa. where said Vehicle had been parked after accident. I collected all the relating particulars
& physically verfied its Chassis No. & Engine No.I found the vehicle damages affacted at its Lh side
mainly. Due to impact I found its --
Loss position was discussed in details with insured & repairer. Estimates submitted by insured & received
through your good office were item wise checked & discussed in details I arranged photographs of
accidental vehicle for claim records. Outer parts were dismentalled to ascertain interior damages . After a
quite lengthy repeated pursuations the loss was assessed keeping in view the cause & nature of
loss.Details of loss assessed as per details on attached sheet :-
VIJAY KR. BHATIA Email vkbhatia81@gmail.com
LABOUR
Sl. No. PARTICULARS ESTIMATED ASSESSED
1 Workshop Labour 600.00 252.00
2 Lh Click painting 1200.00 999.60
3 Lh Floor painting 700.00 NA
4 Lh Cover painting 800.00 699.60
5 Fork Aligment Repair 350.00 NA
Total 3300.00 1951.20
Add 15% Service Tax 495.00 292.68
Total Assessed Labour 3795.00 2243.88
SUMMARY OF ASSESSMENT ESTIMATED ASSESSED
1 COST OF NEW PARTS 5311.22 2418.53
2 COST OF NEW REPAIR 3795.00 2243.88
3 TOTAL LOSS ASSESSED 9106.22 4662.41
4 Less Policy Clause 100.00
5 Less Salvage Value 120.93
6 Net Loss Assessed 4441.49
REISNPECTION
Under advices I again reisnpected the vehicle after repairs I found all the recommended parts
newly replaced/repairings done properly.
REMARKS
1 Rates of New Parts assessed are as per Authorised Dealer Price List
2 Damages assessed are attributed to cause & nature of accident.
3 Engine & chasis numbers are physically verified
ENCL VIJAY KR.BHATIA
1 Estimate, Claim Farm SURVEYOR & LOSS ASSESSOR
2 Photocopy of RC, Ins policy , Photographs & Fee Bill
VIJAY KR.BHATIA
Surveyor & Loss Assessor
TOTAL 1140.00
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VIJAY K.BHATIA
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144 7
1747 80 78
1524 81 73
75 85
85 76 81
167 88 83
231 82
323 400
291 482
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133
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1077
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117
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170
189
228
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1024
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