Beruflich Dokumente
Kultur Dokumente
01482-250839, 98291-86845
Surveyor & Loss Assessor 6-D-33, New Housing Board
Licence no. SLA-49290 Shastri Nagar, Bhilwara (Raj.)
Valid Up-to : 22.11.2019 email:piyushmathur08@gmail.com
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PIYUSH MATHUR PM/NICL/SW-5557/04-19/F/01889 - RJ-09-SW-5557
CAUSE & NATURE OF ACCIDENT :
As stated by insured in the claim form & explained to the undersigned that on the way ### ,causing damage to the
vehicle.
POLICE ACTION : Not reported
DETAILS OF LOAD / PASSENGER : NA
Insured submitted the estimate of M/s Jain Auto Corp., Chittorgarh. , Rs. 11423.98
NEW PARTS :
Assessed F
HSN Bill Estimated GS
S. No Parts Description Remark Glass/ 2nd
Code S. No F Metallic (25) Non Metallic T
Hand/ Repair
SUMMARY OF ASSESSMENT :
PARTICULARS ORIGINAL ESTIMATE ASSESSED FOR
Sr. No. Service Acc. Code GST % Actual Allowed C GST S GST I GST Total
Based on details provided above, the liability under the subject policy of insurance works out to F 3,480.00
(RUPEES THREE THOUSAND FOUR HUNDRED EIGHTY ONLY) The assessment of loss, as detailed above, is subject to
the terms and conditions of the policy of insurance.
Remarks :
1. Cause and nature of accident appears to be genuine and believable.
2. All documents have been verified from originals and found in order.
3 Rates allowed for replacement of parts are as per authorized dealer price list and repair allowed as per
prevailing market rates.
4. Vehicle was Re-inspected after repair and found that all the parts repaired / replaced which allowed.
PIYUSH MATHUR
SURVEYOR & LOSS ASSESSOR
Enclosures : Survey Fee Bills, Claim Form, Estimate of repairs, Photographs [<PT> Nos.] .
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