Professional Documents
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Claim Check List (Motor)
Claim Check List (Motor)
Claim Check List (Motor)
FORM-MOC-020
MOTOR CLAIM CHECK LIST
DOCUMENTS ATTACHED
S/N DESCRIPTION YES NO N/A PAGE # REMARK
1 Duly Completed Claim Notification Form
2 Photocopy of Driving License
3 Photocopy of Title Certificate
4 Traffic Police Report
5 Photographs
6 Post Risk Survey Report
7 Settlement of Excess
8 Settlement of Outstanding Premium
9 Collection of Proforma from four Garages
10 Work order (Body)
11 Work order (Mechanical)
12 Survey Report for Mechanical Damage (if any)
13 Dealer’s Proforma Invoice
14 Parts Price Comparison Table
15 Any Additional Survey Report
16 Breakdown of Contribution imposed
17 Satisfaction Note
18 Collection of Salvage Items
19 Discharge Note (for total loss)
20 Power of Attorney (for total loss)
21 Title-deed book (for total loss)
22 Other Relevant documents (List below)
23 Provision Adjustment Previous 1stRevison 2ndRevison 3rdRevison
Amount
Date
ADDITIONAL DOCUMENS REQUIRED For TP CASES
A For BODILY INJURY / DEATH
1 Police Report Indicates Name of Injured
2 Medical Bills Attached
3 Medical Board Certificate (if appropriate)
4 Post Mortem Certificate (if death occurred)
5 Legal Heirs Certificate
-
-
B For PROPERTY DAMAGE
1 Police Report Indicates Name of TP Owner
2 Survey Report
3 Proforma Collected form four Garages
4 Ownership Certificate of Third Party
5 Discharge Receipt
-
-
Number of Pages in the Claim File
Not Applicable
THE UNITED INSURANCE COMPANY S.C
CHECK LIST FOR MOTOR CLAIM
Detail of Claim
Name of Insured :
Claim No. :
Policy No. :
Period of Insurance :
Plate/Type of Insured Vehicle:
Sum Insured :
Excess (if any) :
Date of Accident :
Type of Accident :
Date of Report :
Approval required for (body work, mechanical work, third party property/bodily injury or death,
guarding etc): ______________________________________________________
_________________________________________________________________________________
_______________________________________________________________
CHECKED BY : APPROVED BY
DATE :