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Our Ref.

#: PCA/M/201245
27th October 2010

Zenith Packaging Industries

Plot No. W-170(B),
MIDC Industrial Area,
Taloja, Raigad - 410208.

Dear Sir,
Kind Attn: Mr. Rajesh J. Parekh

Re: Loss and damage by fire on 25th October 2010 at about 2.00 p.m. to the stocks of

Zenith Packaging Industries located at Plot No. W-170(B), MIDC Industrial Area, Taloja,


We refer to your above claim and to our visit to your factory at Taloja on 26 th October 2010.
During the visit we observe the damages and held discussions with you. We had collected the
information/documents that were provided to us. Now to proceed further with the processing
of your claim, please provide us the following information/documents,
1. Copy of claim form duly filled in & signed.
2. A detailed statement describing the Occurrence. Please describe the origin of fire, its
detection and spread, fire fighting efforts made and control of the fire, with all
time factors in proper sequence. Please also mention the time of arrival and departure of
fire brigade tender, who attended the fire, and also the place from where they came. Any
difficulties faced in fighting the fire may also be brought out clearly.
3. Your opinion about cause of fire / loss.
4. Copy of FIR.
5. Copy of Panchnama.
6. Copy of fire brigade report.
7. Copy of news paper cutting (if any)
8. Claim bill on your letter head (i.e. type of product, qty., amount, etc.) along with all
supporting documents such as invoices, payment proofs, challans, etc.

Regarding loss to Stocks

9. Copies of complete Audited Balance Sheets for the last 5 years i.e. 05-06, 06-07,
07-08, 08-09 & 09-10.
10. Trading account for the period 01.04.2010 till the date of loss duly certified by the
chartered accountant.
11. Detailed day wise sales and purchases record from 1st April 2010 till date of loss.
12. Monthly statement of stocks submitted by you to your banker for the last 6 months
providing the item wise details of the stocks for the affected location covered under
the policy.
13. Your item wise statement giving the total quantities and values of the entire stocks
(as Insured under the Policy) lying in the factory premises at the time of fire, on the
basis of your cost price (with & without modvat / excise duty, if applicable); supported
by the copies of the relevant invoices and/ or cost sheets for the quantities and rates
taken, and certified by your Auditors.

14. Details to arrive at the quantity claimed by you for the affected / damaged raw
material, WIP and finished goods.
15. Copy of stocks register (inward / outward).
16. Copies of the Excise Returns of Stocks submitted by you to Excise Department
between 01.04.10 and date of fire.
17. Certificate from the Excise department giving the item wise quantities & values of
stocks lying in the factory at the time of fire.
18. Copies of the VAT record for the period 01.04.10 till date of loss, duly certified by
VAT Authorities.
19. For semi-finished and finished stocks please provide us the copy of purchase order,
job cards, copies of delivery challans/ bills etc.

20. Salvage value of the damage items.

21. Kindly keep the damaged items in safe custody till any further instruction from us.
22. In case, we require any further documents / information after perusal of above, we shall
advise you in due course of time.

Please submit us the above documents at the earliest.

Thanking you.

Yours sincerely,
for Puri Crawford & Associates India Pvt. Ltd.

A. N. Maurya
(General Manager)

Cc: Bajaj Allianz General Insurance Co. Ltd. Kind Attn. – Mr. Amol Salvi

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