SATISFACTION NOTE

TO
Tata Aig General Insurance Company Ltd.,
Raheja Towers, 9th Floor,
177 Anna Salai
Chennai 600 002.

Dear Sirs,
Policy No.__________________________________ Claim No.________________
The repair to my/our vehicle No.________________________ have been completed to my/our entire
Satisfaction by ________________________________________________ and I / We agree that the
Payment to them of the Repair Bill No.___________________ dated ________________ for Rupees
__________________________By you will discharge in full your liability under the above policy in
respect of the accident which occurred on the ____________________day of _____________200
PLACE:
DATE:

Yours faithfully,
(Insured)
REPAIRERS CONSENT

We agree that payment of the above mentioned bill to us will settle our account in full in respect of the
Repairs carried out to the above vehile in the said accident.
We hereby undertake to keep the salvage in the safe custody pending your advice regarding disposal
Thereof.
PLACE:
DATE:

____________________________
(Repairers)