‘CLAIM INTIMATION LETTER Ps Legana Irasn psu iony mullMaacay £0 Nits ‘Tekphoue/ Mobile No: 7 2008 psd Te NATIONAL INSURANCE COMPANY LIMITED, Lo Ppa a earale coo, Dear Sir, Re: Acoitw WehicleNo: Hv HA AF OULS [sie regret to inform you that myfour abu mentioned vehicie ban met with an oceans Insurance Policy Number: SO Low 3) 22-0000 E> Ped of rsuence iqhiiaere — F) ipo Date and Time of Accident «=: ||. 8 a lus an ns : onet pao, (TO: & Wow the accidest occured ace en hs OU, amu ood Rh bee pack Pe con CIN tae Damaged oe Fest tee See then Name of Driver atthe nme ofaccidet oF he fone Wie would request you to kindly cegister the claim and issue me a claim form ‘Thanking you, oery pr] 8/23 ‘Yours faithfully,{S8UE OF TINS FORM DOES NOT REPLY ACCEPTANCE OF LIABRLITY. PLEASE GME AL THEDETALS ASKED FOR INTHE CLAM FOL CLAM FORM TO BE PLLED AND SIGNED BY THE NGURED OLY. PoteyWo_GS0400 3122 teecs 75> claim No, ; (For office use only) pres Vehide No TH MIAF C468 ie No 293 Fan B1SDIG Le TE li ee ee Name. Ee Ae 96 cation a ola &. Detar (yr-lOe, mu liCeai Lo stop = ‘Mobile No_=] Amos PSUs Mall d_ = Deiads of her existing insurance poly Ges) respect of tis scckdomt BE LS aa RE ES ES Ee Dele & Tame of Accident! Occurence 1) /F/23 1/40 7 Place ofoee_17n0UY canes TypeofLoes: C3 Damage + Theft Cl ThidPary Extmaiad ContofRepaig_ —TOBSO/= SHV? OM” EN ‘Short Description of Accident Inddent_Hhicc eat Tirufur on fy woy fifo sol wert tus whobr pyucy BuO - DRA Cerin feah 5 r Owner 1 Paid Driver 1 Reiativertiond (Driving License No_ 74 3 Aros COOLEST Vaid upto_3)) #/2 5 ‘Aastorised to drive cw Lehn 5 PenmitNo__— Valid Up to_— lean Authority ‘Fltwess Cericate Vad Upio________No. of fare paying Passengers cated Weigt and Notur of Goods Garied____ RIL No, 110] Police Report Lodged: Cl Yes Cl No, yes, FRUGD No, Police Staion Name wat. Ff S- ‘Deattinjury to any occupant / Third Pasty (others) ancior Thiet Party Property Demegs: = Yes = No Detals in case of Deth andlor jury to Third PartylOccupantsDrver or damage to property: 1 C38 noo 0(23 ‘We the sbove named, do hereby, to the best of myiour knowledge and belie, werrant the tuth of the foregoing statement in ‘every respect and iWe agree thet if /We have made or in any further declaration the compeny may require in respect ofthe said ‘accident, shall make ary flee or fraudulent statement or ary suppression or concealment the policy shall be void and allright to recover there-under in reepect of past or future accidents shall be forfeited. { understand that the company reserves the right of \eriicaton of facts and documents relajing to policy and the claim. Dete_/5 15)23 place Oo = Ty Signature of the insured. 11. Please attach a photocopy of your blank | cancalied cheque for NEFT purpose.Government tof ‘Tamil Nadu y— aot. wea soeaetIndia Driving Licence(Tamituadn) mh OLA 13 2on5000)887 LOGANATHANS PALAMISAMY B -THALAKLINDA suucara Tia MaLs|TAMILNADU POLICE ' wes 9551 nb: ANNUAL ‘eraciab? COMBaTORE sirans Benn a es 1. soe Quptiucs. G9 & SpwP16-08-2023 47.4, 2. nove gust PEM TO Choe gy qcperuid CORO sour pnt exec At —= LOGANATHAN 14 3] CO) PALANISAtty, 442/110 MULLIKORAI, MULLIKORAI-PO, NiLGInIS- 7200805406 21.08.2023 tb Ga) BOLELMED op Qansirer Gaseing. send Genii enficd iol @cumenerustd TO sicngoni Gee : HOROSS cicbgont Son Bar KEAe vo Oe : Gung erflMed cubs TN 40 x 3. ope madtnsu wp Berradsatrcey y Dreher PONMAN- Wc a Note py ies baatae Pan 0 Rm the ile ates ci yee pata Ce Heservi inte ost stats vist mit: o ton using CSA“eh et wre, ot civ Yom Heat noun on auans AE TS, jwo028 meee aanmrete e om te een FE aeemenremtmanreton_ ein eee = ecessuote Recopt umber end Data _s02008%22100012%00¢ 190172028 wrt wersest ter Venice Ou Damage Insurance Deals seeder No Gaim Bonus 1,900.00 poe ge = eco enn | a ag a men SG a ec eeeretecormenent ebm cime ceo eee sl ten ston er Personal Accent Cover Detale wonncsl ‘eerste ems PA ct Own diver one wae Tones MODHEEN KUTTY, PATHE, 85 + 16.0000000, ree Unnamed pasengs Sate pone ‘esna00.00 idee er i : 2, eee, ST TOO $.ateon Sr Hoa 7 i ence soiree Nc