9045559710, 9559571425

DHEERAJ PANDEY 88, BHARDWAJI MANDI,

Govt. Approved Surveyor MUNNU GANJ PHATAK
(SLA 121928 Validity 12 Jan. 2024) dheeraj2228889@gmail.com Shahjahanpur - 242001

18-06-2022

MOTOR SURVEY REPORT (SPOT)

This report is issued by me as licensed Surveyor without prejudice, in respect of cause, nature and
extent of loss/damages and subject to the terms and conditions of the Insurance Policy:

Policy No. 221401/31/2022/2755 Insurance Co’s

Period of insurance 31-10-2021 to 30-10-2022 Claim No.
1. INSURERS : The Oriental Insurance Co. Ltd.,
(Address) Shahjahanpur

2. INSURED : Sanjeev Kumar Katiyar

(Address) Rang Mahela, Shahjahanpur

3. Financiers, if any : Nil

4. VEHICLE PARTICULARS To be verified, Noted From Xerox

(a) Registration No. : UP27AT 1365
(b) Registered owner : Sanjeev Kumar Katiyar
(c) Date of Registration : 17-11-2017
(d) Chassis No : 21609
(e) Engine No : 30523
(f) Make/Model : Tata LPT 3718/2017
(g) Type of body : Truck (Open Body)
(h) Class of vehicle (use) : Goods Carrier
(j) Pre-accident condition : Satisfactory
(k) Registered laden weight : 43500 Kgs.
(l) Un-laden weight : 9415 Kgs.
(m) Fitness No./Validity : 16-11-2023
(n) Seating capacity : 6 in all
(o) Road tax paid up to : To be verified

5- PERMIT PARTICULARS To be verified, Noted From Xerox

(a) Permit No
(b) Name of holder
(c) Valid up to
(d) Type of permit
(e) Area of operation
: NP/UP/25/042022/99665 (Basic), UP/25/NP/MAG/2019/438 (NP)
: Sanjeev Kumar Katiyar
: 01-05-2023 (NP), 02-05-2024 (NP)
: Permanent
: All India

6- ACCIDENT
(a) Date & time of accident : 16-06-2022 at 06:30 AM
(b) Place of accident : Near Vill.- Sisnai, Chandapur, Shahjahanpur
(c) Date of survey : 16-06-2022
Contd…...2
 2

Report Dheeraj Pandey Contd…

7- DRIVER PARTICULARS To be verified, Noted From Xerox
(a) Name : Satya Prakash
(b) No. : UP27 19990005611
(c) Date of issue : 10-09-2021
(d) Valid up to : 24-03-2025 (NT), 09-09-2026 (T)
(e) Issuing authority : LA Shahjahanpur
(f) Type of license : LMV Only
(g) Endorsement : Trans w. e. f. 05-10-2001

8- MISC. INFORMATIONS
(a) Passengers at the time of accident : Two (Driver + Helper) Only
(b) Injuries to driver/occupant : No/Nil
(c) Police report : Not Lodged till spot, advised to lodge the same
(d) T.P. involvement/loss : No/Nil

9- LOAD BEING CARRIED : Loaded with Grit, GR No. 1814

Ex. Rampur to Shahjahanpur

10- CAUSE-NATURE OF ACCIDENT
: As told by the insured that captioned vehicle was heading
to destination side, closer to the site of accident, at the time
of taking turn, suddenly soil of rear right side tyre got sunk,
vehicle became unbalanced & got overturned on its R/side,
thus it sustained damages.

11- OBSERVATIONS

A) Registration/DL/Permit/Fitness/GR particulars to be verified/as produced. Chassis

number physically verified.

B) Soon after having instructions from office on 16-06-2022, the undersigned made a
visit to site, Near Vill- Sisnai, Chandapur at Shahjahanpur and carried out the
inspection, in reported condition. The loss and circumstances were discussed with
driver, necessary photographs were also arranged to visualize the extent of
damages, which are self explanatory, enclosed herewith.

C) After weighing all sort of evidences/physical verification of damages, I opine that

questioned vehicle sustained accidental damages, resultant to reported
circumstances and also looking very fresh.

LOSS SUSTAINED TO THE INSURED’S VEHICLE NO. UP27AT 1365

CABIN ASSEMBLY : R/side of cabin pressed, all joints strained, inner structure
upsets, R/Side pillar, roof, bent. Mica cracked at various
places. Right door pressed, hinges bent, door glass
machine, trim/handles/lock/RVM pressed-under impact-to
be checked.

W/S GLASS : Both Broken

DASHBOARD : All joints strained, Entire structure shaken due to impact.

COOLING SYSTEM : Radiator & other sub-assy Intact, mountings strained.

POWER SYSTEM : Engine and other sub assemblies safe, mountings strained.
Air cleaner/Pressure pipes pressed. Fuel tank pressed-diesel
leaked.

CHASSIS : Both longitudinal member bent/loss is to ascertained at the

time of final survey.

FRONT AXLE/ DIFFERENTIAL : I-beam/Differential o.k./intact. Rear right outer rim-to be

checked as seems, under impact.

TRANSMISSION : Controlling paddles/Clutch/gear housing o.k./intact.

STEERING SYSTEM : Appreantly intact, Tie rod/R-S bend arm bent.

SUSPENSION : Front both sides leaf spring intact. Rr R/side impact,

U&C joints to be check.

LOAD BODY : All body angles bent, joints strained, floor upsets.

ELECTRICAL SYSTEM : Wiring dislocated. Battery acid drained out,

terminal shaken.

Encl. Your’s truly

1-Fee bill
2-Photographs - 08 digital

(DHEERAJ PANDEY)
 9045559710, 9559571425
DHEERAJ PANDEY 88, BHARDWAJI MANDI,
Govt. Approved Surveyor MUNNU GANJ PHATAK
(SLA 121928 Validity 12 Jan. 2024) dheeraj2228889@gmail.com Shahjahanpur - 242001

FEE BILL
Bill No. OIC/8/2022 Date- 18-06-2022

To,
The Manager
……………………………………………
The Oriental insurance Co. Ltd.
……………………………………………
Shahjahanpur
……………………………………………

Re: Claim Number

Policy/Cover Note Number 221401/31/2022/2755
Pertaining to UP27AT 1365
A/C Sanjeev Kumar Katiyar
Recipient GST No.
--------------------------------------------------

1. Survey fees on Spot . Rs. 850.00

2. Photographs 08 No@10/- Rs. 80.00

4. DA 30% Rs. 250.00

3. Conveyance 32 KM bu bike @ 7.25/- (both sides) Rs. 232.00

-
----------------
TOTAL Rs. 1412.00
----------------

(DHEERAJ PANDEY)

_____________________________________________________________________________________
PAN NUMBER CQAPP6081J, A/C No. 20070091746, SBI CHOWK MANDI
MICR 242002004, IFSC SBIN0004000