SURVEYOR NAME

Surveyor & Loss Assessor

Motor, Engineering & Misc.
C-X/XXX,Sector-8, Rohini, Delhi-110085
IIISLA No : F/N/000XXX
License No. : SLA 15XXX Phone No. : 011 4753XXXX
Valid Upto : 03/03/2020 Mobile No. : 981003XXXX
GST No. : 07ABDPK3847XXXX Email ID : surveyorname@gmail.com
PAN : ABDPK3XXXX SAC Code : 997139

MOTOR (FINAL) SURVEY REPORT

Private & Confidential
Report No.: AK/OIC/MAR/2017-18/035 Date: 29/03/2018

This report is issued without prejudice, in respect of cause, nature and extent of loss/damage and
subject to the terms and conditions of the Insurance Policy and Insurer admitting liability.

Policy No. : 215700/31/2018/13XXXX

Insurance Period : 05/10/2017 To 04/10/2018

Insurance Co's Claim No. : 215700/31/2018/6XXXX
POLICY TYPE : NORMAL
STATUS OF 64VB : CONFIRMED FROM OFFICE & FOUND IN ORDER
PAYMENT MODE : ISSUED IN FAVOUR OF M/S Rana Motors,
Jahagirpuri, Delhi.

Insurance Particulars

Insurer : The Oriental Insurance Co. Ltd.

D.O.-25, Maruti Insurance Nodal office, 88, Janpath,
New Delhi.
Insured : Mr. XXXX Meena
House No:- XXX Gali No 4X, Parwati Anchal, Sant
Nagar, Delhi M-956036XXXX
IDV : Rs. 299750.00
HPA With : None

Vehicle Particulars RC: Verified

Registration No. : DL-1CN-XXXX

Registered Owner : Mr. XXXX Meena
Date of Registration : 08/10/2013
Date of Transfer/SrNo : 01
Chassis No. : 52XXXX Physically Verified : Yes
Engine No. : 43XXXX Physically Verified : Yes
Engine Capacity : 1248 CC
Vehicle Make : Maruti Suzuki
Vehicle Model : Sep 2013
Vehicle Variant : Swift VDI
Type of Body : Saloon
Pre- Accident Condition : Avergae
Colour of Vehicle : P Arctic White
Tax paid upto : OTT
Class of Vehicle : L.M.V
Seating Capacity : Five(5)
Odometer Reading : 31563 Kms
Fuel used as per RC : Diesel

Driver Particulars DL: Verified

Name of the Driver : Mr. XXXX Meena

 AK/OIC/MAR/2017-18/035 DL-1CN-XXXX Page 2 of 4

Relation with the insured : Owner

Driving License Number : DL-011999008XXXX
Valid from : 17/09/2015 Upto 09/10/2020
Issuing Authority : Delhi
Type of License : Permanent
Type of Vehicle Allowed To Drive : LMV & MCYL ONLY

Accident Particulars

Date and Time of Accident : 23/03/2018 09:45 AM

Place of Accident : Sant Nagar, Delhi
Place of Survey : M/S Rana Motors, Jahagirpuri, Delhi.
Date of request for Survey : 24/03/2018
Date and Time of Survey : 25/03/2018

Anti Theft Device Status : Yes

CNG/LPG Kit : Not Applicable

Particulars of Police Report

Has accident been report to Police : The matter was not reported to police station
Has Panchnama been carried out :

Particulars of Third Party Injury/Loss : As per claimform there was no third party loss in this
accident

Cause and Nature of Accident

As per stated in claimform IV was playing on the road suddenly a good speed E-rickshaw came in front
of IV and dash with IV & run away, in order to save the E-rickshaw insured took the turn on left side
and hit with pillar. Resulting the damages

Remarks & Recommendations

Pursuant to the instruction received from "Motor Claim Department" of The Oriental Insurance
Co. Ltd., D.O.-25, Maruti Insurance Nodal office, 88, Janpath, New Delhi. on 25/03/2018
and as desired the undersigned visited at repairer place on 25/03/2018 to survey the loss to
above mentioned vehicle reported to have met with an accident.

The vehicle was examined very minutely and damages sustained by it were noted down. The loss
can be attributed to be accident in nature and the damages quite in accordance with the history of
said accident.

Original Estimate
Estimate no. E8005XXX dated 24/03/2018 for Rs.61420.88 was submitted by M/S Rana Motors,
Jahagirpuri, Delhi..

Status of the Workshop : M/s Rana Motor, Jahangir Puri, Delhi

SALVAGE
Salvae of recommded new parts were destroyed in my presance at the time of final survey.
LOSS ASSESSMENT

ASSESSMENT OF LOSS (PARTS)

S. Description of Parts QE QA Est. Rate CGST SGST Estimated Assessed Parts Amount Remark
No. % % (Amt in Rs)
Metal Rub/Plast Glass

1 AC Condensor 1 0 5349.00 14 14 5349.00 - - -

2 Inter cooler 1 1 4521.00 14 14 4521.00 3792.90 - -
 AK/OIC/MAR/2017-18/035 DL-1CN-XXXX Page 3 of 4

3 Fan cooling assy 1 0 4325.00 14 14 4325.00 - - -

4 Radiator assy 1 0 3600.00 14 14 3600.00 - - -
5 Head light R/H 1 1 2397.00 9 9 2397.00 - 2031.30 -
6 Pipe liquid 1 0 1768.00 14 14 1768.00 - - -
7 Front bumper 1 1 1735.00 14 14 1735.00 - 1355.40 -
8 R/H Fender 1 0 1196.00 14 14 1196.00 - - -
9 Hose suction 1 0 1158.00 14 14 1158.00 - - -
10 Fog light 1 0 1069.00 14 14 1069.00 - - -
11 Hose inter cooler inlate No-1 1 0 1056.00 14 14 1056.00 - - -
12 Hose discharge 1 0 1055.00 14 14 1055.00 - - -
13 Hose inter cooler outlet No-1 1 0 834.00 14 14 834.00 - - -
14 Hose inter cooler inlate No-2 1 0 610.00 14 14 610.00 - - -
15 Hose inter cooler outlet No-2 1 0 393.00 14 14 393.00 - - -
16 AC gas 1 0 320.00 14 14 320.00 - - -
17 Radiator grille upper 1 1 512.00 14 14 512.00 - 400.00 -
18 Washer pump 1 0 247.00 14 14 247.00 - - -
19 Radaitor grille lower 1 1 227.00 14 14 227.00 - 177.30 -
20 Washer tank 1 0 160.00 14 14 160.00 - - -
21 Fog lamp bezel R/H 1 0 84.00 14 14 84.00 - - -
22 Rear door L/H 0 0 0.00 14 14 - - - -
23 Hood panel 0 0 0.00 14 14 - - - -
24 Qtr panel L/H 0 0 0.00 14 14 - - - -

Total 32616.00 3792.90 3964.00 0.00

Add CGST @14.00% 0.00 531.01 270.58 0.00
Add SGST @14.00% 0.00 531.01 270.58 0.00
Add CGST @9.00% 0.00 0.00 182.82 0.00
Add SGST @9.00% 0.00 0.00 182.82 0.00

Total 32616.00 4854.91 4870.79 0.00

Less Dep @ 35.00% on Metal, 50.00% on Rub/Plast, 1699.22 2435.40 0.00

0.00% on Glass Parts, 30.00% on Fibre Parts.
Total 3155.69 2435.40 0.00

Total 5591.09

LABOUR CHARGES

S. Description of Labour Remarks Estimated Assessed

No. (Amt in Rs.) (Amt in Rs.)

1 Replacement of Inter cooler 525.00 100.00

2 Replacement of Fan cooling assy 525.00 -
3 Replacement of Radiator assy 525.00 -
4 Replacement of Head light R/H 105.00 50.00
5 Replacement of Front bumper 525.00 100.00
6 Repair of R/H Fender 525.00 100.00
7 Replacement of Fog light 105.00 -
8 A.C Gas Charging of AC gas 315.00 -
9 Repair of Rear door L/H 525.00 -
10 Repair of Hood panel 525.00 100.00
11 Repair of Qtr panel L/H 750.00 -

Total 4950.00 450.00

Add CGST @9.00% 0.00 40.50
Add SGST @9.00% 0.00 40.50

Grand Net/ Total 4950.00 531.00

PAINTING CHARGES

S. Description Remarks Estimated Assesed Material Labour

No. (Amt in Rs.) (Amt in Rs.) (Amt in Rs.) (Amt in Rs.)

1 Painting of Fender R/H 3108.00 2175.00 543.75 1631.25

2 Painting of Front bumper 4773.00 4295.00 1073.75 3221.25
3 Painting of Rear door L/H 4612.00 - - -
4 Painting of Front hood panel 4923.00 2953.00 738.25 2214.75
5 Painting of Qtr panel L/H 2800.00 - - -
 AK/OIC/MAR/2017-18/035 DL-1CN-XXXX Page 4 of 4

6 Painting of Front bumper 4773.00 4295.00 1073.75 3221.25

7 Painting of Rear door L/H 4612.00 - - -
8 Painting of Front hood panel 4923.00 2953.00 738.25 2214.75
9 Painting of Qtr panel L/H 2800.00 - - -

Total 20216.00 9423.00 2355.75 7067.25

Add CGST @ 9.00% on Material, Add CGST @ 9.00% on Lab 1819.44 212.02 636.05
Add SGST @ 9.00% on Material, Add SGST @ 9.00% on Lab 1819.44 212.02 636.05
Total 23854.88 2779.79 8339.36
Less Dep @50.00% 1389.89
Total 1389.89 8339.36
Grand Total 9729.25

Net Labour Amount (O/F & D/B + Painting Labour) 10260.25

Summary of Estimate and Assessment of Loss

Estimated Assessed
(Amt in Rs.) (Amt in Rs.)

Total Cost of Parts 32616.00

Parts (Metal) 3155.69
Parts (Rub/Plast) 2435.40
Parts (Glass) 0.00

32616.00 5591.09

Net Labour Charges 28804.88 10260.25

TOTAL 61420.88 15851.34

Compulsory Deductable (-) 1000.00
Less Salvage (-) 243.00

TOTAL 61420.88 14608.34

Net Liability on Repair Basis 14608.34

Net Liability
Based On Details Provided Above, The Lowest Liability Under The Subject Policy Of Insurance Works
Out To Rs.14,608.34 (Rupees Fourteen Thousand Six Hundred Eight and Thirty Four paise Only)

SURVEYOR NAME
Surveyor & Loss Assessor

Enclosures:
1.Survey Fee Bill 2.Bill/Invoice 3.Claim Form 4.Copy of D.L. 5.Estimate Copy 6.Satisfaction Voucher
7.Intimation Letter 8.Discharge Voucher 9.Copy of R.C. 10.Copy of Policy/C. Note 11.Photographs 9