A.

SPOT SURVEY REPORT

Name of the Surveyor Address

License No and Phone/Mobile
IIISLA
Membership No
Date of Expiry E mail
REPORT NUMBER REPORT
DATE

MOTOR SPOT SURVEY REPORT

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.
Cover note / Certificate of
Insurance No
Policy No.
Period of cover
Date of Loss/Accident
IDV of the vehicle
Insurance Company’s Claim No.
Policy Issuing
Office and
Address
Name of the
Insured and
Address
Insured Name of
Details Insured’s
representative
present at the
spot
Financiers /
Hypothecation
if any
Vehicle Registration No
Particulars Make and Model
Year of
Manufacturing
 Date of
Registration
Chassis Number
Engine Number
Class of vehicle (
Use )
Type of body
Registered laden
weight
Un-laden weight
No. of persons
permitted as per
RC
Permit No &
valid up to
Authorization
No & valid up to
Area of
operation /
Route
Fitness
Certificate
valid up to
Road tax valid
up to
Odometer
reading
Pre Accident
Condition
(any distortion in painting , breakage of glasses , pre-accident
Other details patch repairing and exterior wear and tear including tyre
treads )
Driver Name of driver
Particulars Driving License
No
Date of issue &
valid up to
Licence Issuing
Authority
 Authorized to
drive
Badge No
Endorsement on
licence if any
Nature of goods (Give detailed comments in case of hazardous goods)
carried and
packing
(Give detailed Comments if exceeds permitted capacity.Also
Weight of goods
Load comment whether physical volume of goods has been cross
carried
Challan/ checked with weight shown in load challan)
Trip Sheet Origin and
Details Destination
LR/Invoice No
and date
Transporter ‘s
Name
Number of (Give detailed Comments if it exceeds permitted capacity)
passengers
Passenger
carried
Details
Occupants and (Give detailed comments as to the capacity in which each of the
details passengers was carried in the vehicle)
Date & Time of
accident
Place of accident
( Write if place
of survey is
different )
Survey
Accident
Allotment Date
Particulars
Survey
(Write date and time )
conducted on
Cause of
Accident as
stated by (Write comments about consistency of damage and if damages are
Insured not corroborating with the cause)
representative
Fatality/ Details of TP (Vehicle Registration No. with short description of damage
Injury Vehicle &insurance particulars of TP vehicle)
Details Death/ Injury ( Nature of injury , name , age and locality where resides in respect
 details
concerning the
of each person with supporting documents, if available)
accident of
insured vehicle
Death/ Injury
details of TP
Vehicle
Third Party
Property (Write TP PD details)
Damage
Witness (Name & Address & Telephone No.)
Name of the
police station
Police
FIR No and date
Report
& sections
Details
GD and 100 No
dial
Whether
R FC PERMIT TAX DL CHALLAN/ OTHERS
documents
C TRIP
verified , if so,
SHEET
what are they
(Put a tick)
Serial Numbers
of major parts
and assemblies
damaged
Whether MVI
Other
Inspection done
Details
Number of
and
photographs
Remarks
enclosed
Whether towing
required
Where will the
vehicle be
shifted to?
Was the vehicle
left unattended
after accident? If
so, why?
 VISUAL
DAMAGS
INSPECTED
AT THE
Brief Description of the damages
SPOT List of parts
( Technical
description
of damage )
Inconsisten
Brief Description of the damages which are not related to the
t Damages List of Parts
subject accident
Noticed
Close Details of close
Any special comments about close proximity
Proximity proximity
Any other comments
(Including any violation of policy terms, exclusions and conditions/Admissibility of the claim and
reasons for the same.)
Every possible care was taken to note down all visual damages however if any internal items remain, a
suitable decision may please be taken on the basis of cause of accident and photographs.

Issued without bias & prejudice.

Enclosures
Photographs and (Mention number of photographs. Photographs – marked with all damages
other evidences with names of damaged parts. Also to include any TP vehicle, injury, property
collected damage)
Pencil Tracing and photographs of engine and chassis number