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
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]

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;-

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-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.
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]

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.

Spot Survey
Spot Survey By : Mr. ------------------., Madurai.
Spot Survey report received on : 25.03.2017 by post
 R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]

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

Sl. No Description of Parts Damage Qty Est. No Estimated Billed Assessed Inv. Sl. No
1 1No. 0.00
2 0.00
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA - 17364 VALID 20/12/2020 Email ID: [email protected]

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 :-

Sl. No Description of Parts Damage Qty Est. No Estimated Billed Assessed Inv. Sl. No
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 :-

Sl. No Description of Parts Damage Qty Est. No Estimated Billed Assessed Inv. Sl. No
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
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA - 17364 VALID 20/12/2020 Email ID: [email protected]

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
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA - 17364 VALID 20/12/2020 Email ID: [email protected]

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
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 :

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.

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
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-RI- Date :

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

HEAD OFFICE: BRANCH OFFICE:

Room No. 74, PG Mansion, NO. 47/35-B-12, Kullanampatty,
N. No. 8&10, Old No. 38 & 391 Nagal Nagar (PO),
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]

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

R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]
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 :

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

HEAD OFFICE: BRANCH OFFICE:

Room No. 74, PG Mansion, Plot No.6, Preethi Nagar, A
N. No. 8&10, Old No. 38 & 391 Palamarathupatti, Nagal Na
Maninagaram Main road, Madurai - 625 001 Dindigul - 624 003.
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-RI- Date :

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

HEAD OFFICE: BRANCH OFFICE:

Room No. 74, PG Mansion, Plot No.6, Preethi Nagar, Annanagar Extn.,
R. NATARAJAN, DME, DAE, FIIISLA MOBILE: 98659 54088
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]

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
LICENSE NO: SLA-17364 VALID 20/12/2023 Email ID: [email protected]