SURVEYOR NAME
[Link]., M.B.A. Insurance Surveyor & Loss Assessor
Licence No: 70707, Validity: 14/09/2019 GST No.: AA0907173123536
Membership (IIISLA) No.: L/N/5857
MOTOR (FINAL) SURVEY REPORT
Private & Confidential
Ref. No.: VN/2017/F/26 Date: 16/03/2017
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.
Subject : Claim for Veh. Regn. No. KA18 B XXXX, Accident Date : 16/02/2017
Insured : [Link] PXX
Policy No. : 60600631161000XXXX
Appt. Officer : DVISIONAL MANAGER
Insurance Particulars
Insurer : THE NATIONAL INSURANCE CO LTD.,
The National Insurance co Ltd, Bussiness center
1930/A,16 th B cross, Bus stand road, New Town
Yalahnka,Bangalore-560064
Appointed By : NATIONAL INSURANCE CO LTD.,
DIVISIONAL OFFICE, MANAJUNATHA COMPLES,OLD
BUS STAND ROAD,HASSAN-573201
Insured : [Link] PXX
PXXXXX PXX, Associates, Chatra Road, Near Rest In
Lodge, [Link], Chikkamalaur,City, Chikkamagalur.
M-82771XXXXX, 97411XXXXX
Policy No./Cover Note No. : 60600631161000XXXX
Period of Policy : 31/01/2017 To 30/01/2018
POLICY TYPE : NORMAL
PAYMENT MODE : ISSUED IN FAVOUR OF INSURED
IDV : Rs. 1050000.00
HPA With : CANARA BANK, MAIN BRANCH, CHIKKAMAGALUR
Vehicle Particulars RC: VERIFIED
Registration No. : KA18 B XXXX
Registered Owner : SaXXXXXX PXX
Date of Purchase : 05/02/2014
Date of Registration : 05/02/2014
Chassis No. : MAT373339D7HXXXXX Physically Verified : Yes
Engine No. : 697TC69GWY1XXXXX Physically Verified : Yes
Engine Capacity : 5675 CC
Vehicle Make : TATA
Vehicle Model : Jan 2014
Vehicle Variant : TATA/LPT 1613 BSIII
Type of Body : OPEN
Pre- Accident Condition : GOOD
Colour of Vehicle : ORANGE
Tax paid upto : 30/02/2017
Class of Vehicle : HGV
Seating Capacity : 1
Odometer Reading : NOT WORKING Kms
Fuel used as per RC : Diesel
Fitness Certificate No. : KA-XX/12XXX/2016-2017 VERIFIED
A-X, XXXXXX Nagar, Behind Vishwakarma Temple, Hirapur Road, Mohaba Bazar, Raipur (C.G.)
surveyorname@[Link], surveyorname@[Link] :: 966907XXXX, 930006XXXX
VN/2017/F/26 KA18 B XXXX Page 2 of 7
Valid upto : 13/02/2018
Permit No. : 5XX/2013-14
Valid upto : 10/02/0219
Authorization No. : PGDC NO;564/3013
Valid upto : 10/02/2019
Permit Type : GOODS CARRIAGE PERMIT
Route / Area of Operation : THROUGH OUT KARNATAKA STATE
Whether valid for the state in which : Yes
accident took place?
Load Challan No. : JYT7890 N/A
Registered Laden Weight : 16200
Unladen Weight : 6150
If overloaded, whether the overloading is
: No.
the cause of accident?
Driver Particulars DL: VERIFIED
Name of the Driver : HXXXXXX KUMAR A.S.
Driver DOB : 05/05/1996
Driver Address : S/[Link], Nagenahalli (PO), Kadur Tq,
Chikkamagalur(DT) 577548
Relation with the insured : EMPLOYEE
Driving License Number : ka182014XXXXXXX
Valid from : 19/08/2016 Upto 18/08/2019
Issuing Authority : RTO, CHIKKAMAGALUR
Type of License : PERMANENT
Type of Vehicle Allowed To Drive : trans
Endorsement Details : Valid Throughtout India, COV to drive is MCWG,
TRANS, LMV CAB,PSVBUS
Badge No. : XXX CAB,1000BUS
Accident Particulars
Date and Time of Accident : 16/02/2017 06:45 AM
Place of Accident : Kushal Nagar, Coorg District
Place of Survey : SRI XXXXXX AUTO DIESEL SERVICE, Uppali,
Malanadur Road,Chikkamagalur
Date of request for Survey : 21/02/2017
Date and Time of Survey : 22/02/2017 03:35 AM
Date of Under Repair visits : 26/02/2017 04/03/2017 15/04/2017 etc
Insured's rep. attending survey : YES, MR. XXXX PXX ATTENDED
Was veh. left unattended after accn : No It is observed some repair works done at the
spot , prior to my inspection.
Previous Claim Details : No
Particulars of Police Report
Has accident been report to Police : No
Has Panchnama been carried out : No
Particulars of Third Party Injury/Loss : No
Injury to Driver/Occupant (If any) : No
Spot Survey
Spot Survey By : ChandXXXXXXXX, of ChikamagaXXX
Spot Survey report received on : 25.03.2017 by post
VN/2017/F/26 KA18 B XXXX Page 3 of 7
Load/Passenger Details
No where insured has reveal about load details, even spot surveyor also not commented about it.
Cause and Nature of Accident
As reported by the insured on the day of occurence insured vehicle coming from Kushal nagar to
Kudige, At the spot of accident, all of sudden front LHS leaves spring perch and its bracket broken and
leading to accident,soon after the break of perch,vehicle went out of driver control and moved
erratically,crashed against electrical poles and up rooted it, further moved in to compound wall of third
party residence,Hence caused the damages to insured vehicle.
Particulars of Loss/Damages
Cabin:Front glass-broken and its rubbr beadings-damaged;Front glass frame-twisted; LHS cabin
damaged and its metal sheets were twisted and damaged badly, the impacts extended to inner portion
also,Hence the wood and angles were -bent;cabin inside sun mica and ply wood also [Link].
Front end structure: Dash damaged;front LH shape panels-pressed badly, Center grill-twisted and
cowl channels were bent,whilr inspecting insured representive and repairer pleaded to allow the new
dash bord assy, After explainging the repair methods, agreed to repair the [Link]
wirings-damaged;Battery-damaged; Front Headlights -damaged;Front Bumper-broken safety
bumper-damaged;front LHs mud gurad-damaged;
Loading Body: Loading Body is metal sheets, it is twisted badly at LHS side and cross wooden beams
were broken;loading anles were bent and require replacment.
Chassis: long memebr at LHS bent badly, insured initially pleaded for the new chassis , but convened
for the disposal, hence the disposal chassis were allowed and it iwas found disposal chassis was 2016
model recent than the vehicle model, hence it was appear as exorbitant rate front bumper cross
memebr-damaged and bent.
Inter cooler and radiator-damaged;steering oil tank and pipe lines damaged; steering yoke milling
damaged and came off,water pump and water pulley were damaged; water body major kit damaged ,
found damages after dismantling,
Main axle: main axle-bent; front king pin set-damaged;Tie rod end assy-bent;Knuckler arm and its
bolts-bent and damaged;Brake booster damaged;Air fileter assy-damaged;engine
bedding-damaged;Front; center bolt-bent.
Original Estimate
Estimate no. EST/SLADS/0010 dated 20/02/2017 for Rs.554,879.32 was submitted by SRI
XXXXXX AUTO DIESEL SERVICE, Uppali, Malanadur Road,Chikkamagalur.
Observation
On through and minute observation of vehicle found that, The cause of accident stated is co-relates
with [Link] damaged parts allowed are confirmatory with causeof accident. appears to fresh
damages and No previous damages found.
(ssued withour Prejudice)
SURVEYOR NAME
Insurance Surveyor & Loss Assessor
Enclosures:
[Link] Fee Bill [Link]/Invoice [Link] Form [Link] of D.L. [Link] of Receipt [Link] Copy
[Link] Letter [Link] Bills [Link] of FIR [Link] of Police Report [Link] of Letter to
Insured [Link] of R.C. [Link] of Policy/C. Note [Link] [Link] by Insured [Link] of Fitness
[Link] of Permit [Link] [Link] Charge Slip [Link] in Duplicate
VN/2017/F/26 KA18 B XXXX Page 4 of 7
LOSS ASSESSMENT
In respect of Vehicle Registration No. KA18 B XXXX, Accident Date : 16/02/2017
(Annexure 'A' attached to Survey Report No. VN/2017/F/26)
ASSESSMENT OF LOSS (PARTS)
S. Description of Parts QE QA Est. Rate Estimated Assessed Parts Amount
No. (Amt in `)
Metal Rub/Plast Glass Fibre
1 Chassis Disposal 1 1 75000.00 75000.00 - - - -
2 Front main axle 1 1 31000.00 31000.00 29000.00 - - -
3 Radiator, Inter Cooler And 1 1 22000.00 22000.00 20000.00 - - -
Brackets
4 Fan Shroud Radiator 1 1 1700.00 1700.00 - - - 1200.00
5 Radiator Viscous 1 1 9600.00 9600.00 - - - 9000.00
6 Water Pump Pulley 1 1 1700.00 1700.00 1500.00 - - -
7 Water Pump Major Kit 1 1 1500.00 1500.00 1200.00 - - -
8 Oil Sump 1 1 3100.00 3100.00 2800.00 - - -
9 Front King Pin Set 1 1 4500.00 4500.00 3800.00 - - -
10 Tie Rod End Assy 1 1 4500.00 4500.00 4200.00 - - -
11 Push Rod Assy 1 1 4600.00 4600.00 4250.00 - - -
12 Knuckle Arm 3 3 1733.00 5199.00 4500.00 - - -
13 Knuckle Arm Bolt 2 2 550.00 1100.00 750.00 - - -
14 Fr Brake Booster 2 2 1900.00 3800.00 3800.00 - - -
15 Fr Bake Pipe 2 2 700.00 1400.00 1200.00 - - -
16 Air Filter Assy 1 1 4500.00 4500.00 4200.00 - - -
17 Power Steering Oil Tank 1 1 2100.00 2100.00 1800.00 - - -
18 Pstg Pipe 1 1 3300.00 3300.00 2800.00 - - -
19 Front Rh & Lh Main Second 5 2 1120.00 5600.00 2240.00 - - -
Blade
20 Front Lh 3rd4th5th Blade 4 2 950.00 3800.00 1900.00 - - -
21 Engine Beddings 2 2 2150.00 4300.00 - 3800.00 - -
22 Fr U Clamps 4 4 400.00 1600.00 1600.00 - - -
23 Front Jula 2 2 700.00 1400.00 1200.00 - - -
24 Shackle Pin 1 1 600.00 600.00 400.00 - - -
25 Center Bolt 1 1 700.00 700.00 600.00 - - -
26 Steering Coupling 1 1 1600.00 1600.00 1200.00 - - -
27 Steering Yoke Milling 1 1 2800.00 2800.00 2500.00 - - -
28 Air Tank Assy 2 2 3000.00 6000.00 4800.00 - - -
29 Air Tank Bracket 2 2 800.00 1600.00 1500.00 - - -
30 Front Grill 1 1 3800.00 3800.00 3800.00 - - -
31 Front Lh Shape Panle 1 1 3700.00 3700.00 3500.00 - - -
32 Front Lh Muid Guard 1 1 2700.00 2700.00 2600.00 - - -
33 Battery 1 1 10500.00 10500.00 - 9500.00 - -
34 Cabin Wiring Materials 1 1 3500.00 3500.00 - - - 3000.00
35 Engine Removing And Refitting 1 1 0.00 - - - - -
After Check Up
36 Front Bumpr Cross Member 1 1 9000.00 9000.00 - - - -
Disposal
37 Cabin Wirings 1 1 0.00 - - - - -
Total 159799.00 113640.00 13300.00 0.00 13200.00
Add CGST @14.00% 22371.86 15909.60 1862.00 0.00 1848.00
Add SGST @14.00% 22371.86 15909.60 1862.00 0.00 1848.00
Total 204542.72 145459.20 17024.00 0.00 16896.00
Less Dep @ 25.00% on Metal, 50.00% on Rub/Plast, 36364.80 8512.00 0.00 8448.00
0.00% on Glass Parts, 50.00% on Fibre Parts.
Total 109094.40 8512.00 0.00 8448.00
Total 126054.40
VN/2017/F/26 KA18 B XXXX Page 5 of 7
Front Show :
(PARTS) (LABOUR)
S. Description of Parts Est Amt. Ass Amt. Est Amt. Ass Amt.
No. (Amt in `) (Amt in `) (Amt in `) (Amt in `)
1 cowl assy repair - - 13000.00 9500.00
Total 0.00 0.00 13000.00 9500.00
Less Dep @ 25.00% 0.00
Total 0.00 0.00
Less Salvage (Front Show) 500.00
500.00
Net Labour Charges for Front Show 9500.00
Net Loss Assessed for Front Show 9000.00
Cabin :
(PARTS) (LABOUR)
S. Description of Parts Est Amt. Ass Amt. Est Amt. Ass Amt.
No. (Amt in `) (Amt in `) (Amt in `) (Amt in `)
1 cabin assy damaged badly atLHS 80000.00 65000.00 30000.00 12000.00
Total 80000.00 65000.00 30000.00 12000.00
Less Dep @ 25.00% 16250.00
Total 80000.00 48750.00
Less Salvage (Cabin) 5000.00
43750.00
Net Labour Charges for Cabin 12000.00
Net Loss Assessed for Cabin 55750.00
Load Body :
(PARTS) (LABOUR)
S. Description of Parts Est Amt. Ass Amt. Est Amt. Ass Amt.
No. (Amt in `) (Amt in `) (Amt in `) (Amt in `)
1 Loading body damaged 40000.00 30000.00 17000.00 7500.00
Total 40000.00 30000.00 17000.00 7500.00
Less Dep @ 25.00% 7500.00
Total 40000.00 22500.00
Less Salvage (Load Body) 5000.00
17500.00
Net Labour Charges for Load Body 7500.00
Net Loss Assessed for Load Body 25000.00
RECONDITION PARTS
S. Description of Parts Remarks Estimated Assessed
No. (Amt in `) (Amt in `)
1 Chassis Disposal Bent and twisted badly 75000.00 50000.00
2 Front Bumpr Cross Member Bent 9000.00 3000.00
Disposal
Total 84000.00 53000.00
ENDORSEMENT ITEMS
VN/2017/F/26 KA18 B XXXX Page 6 of 7
METAL (PARTS)
S. Description of Parts Remarks Estimated Assessed
No. (Amt in `) (Amt in `)
1 Front Bumper Assy Damaged 6500.00 6500.00
2 Front Safety Bumper Pressed badly 9500.00 9500.00
Total 16000.00 16000.00
Add CGST @14.00% 2240.00 2240.00
Add SGST @14.00% 2240.00 2240.00
Total 20480.00 20480.00
Less Dep @25.00% 5120.00
Total 15360.00
Total of Endorsement Parts 15360.00
Less Additional Depn. @ 50.00% 7680.00
Net cost of Endorsement Parts 7680.00
LABOUR CHARGES
S. Description of Labour Remarks Estimated Assessed
No. (Amt in `) (Amt in `)
1 Removing & refitting of Chassis Disposal Bent and twisted badly 13000.00 10000.00
2 Removing & refitting of Front main axle Bent 4000.00 2800.00
3 Removing & refitting of Radiator, Inter Damaged 1500.00 900.00
Cooler And Brackets
4 Removing & refitting of Water Pump Damaged 800.00 350.00
Major Kit
5 Removing & refitting of Oil Sump Damaged 700.00 250.00
6 Removing & refitting of Tie Rod End Bent 700.00 350.00
Assy
7 Removing & refitting of Fr Brake Damaged 800.00 600.00
Booster
8 Removing & refitting of Air Filter Assy Damaged 400.00 150.00
9 Removing & refitting of Front Rh & Lh Bent 6000.00 2000.00
Main Second Blade
10 Removing & refitting of Steering Yoke Damaged 400.00 250.00
Milling
11 Removing & refitting of Engine Alld. for removing/refitting 2500.00 2500.00
Removing And Refitting After Check Up
12 Removing & refitting of Cabin Wirings Damaged 3500.00 3000.00
Total 34300.00 23150.00
Add CGST @9.00% 3087.00 2083.50
Add SGST @9.00% 3087.00 2083.50
Grand Net/ Total 40474.00 27317.00
PAINTING CHARGES
S. Description Remarks Estimated Assesed Material Labour
No. (Amt in `) (Amt in `) (Amt in `) (Amt in `)
1 Painting of Complete Cabin And painting to be done 26000.00 22000.00 5500.00 16500.00
Body Front Cowl Etc Painting
Total 26000.00 22000.00 5500.00 16500.00
Total 26000.00 5500.00 16500.00
Less Dep @0.00% 0.00
VN/2017/F/26 KA18 B XXXX Page 7 of 7
Total 5500.00 16500.00
Grand Total 22000.00
Net Labour Amount (O/F & D/B + Painting Labour) 49317.00
Summary of Estimate and Assessment of Loss
Estimated Assessed
(Amt in `) (Amt in `)
Total Cost of Parts 225022.72
Parts (Metal) 109094.40
Parts (Rub/Plast) 8512.00
Parts (Glass) 0.00
Parts (Fibre) 8448.00
Total Cost of Endorsement Parts 7680.00
225022.72 133734.40
Total Cost of Recondition Parts 84000.00 53000.00
309022.72 186734.40
Net Labour Charges 66474.00 49317.00
TOTAL 375496.72 236051.40
Compulsory Deductable (-) 3000.00
Less Salvage (-) 12000.00
Add Towing Charges (+) 3000.00
TOTAL 375496.72 224051.40
Net Assessed Loss for Body/Cabin 180000.00 89750.00
Net Liability on Repair Basis 313801.40
Net Liability
Based On Details Provided Above, The Lowest Liability Under The Subject Policy Of Insurance Works
Out To ` 313,801.40 (Rupees Three Lakhs Thirteen Thousand Eight Hundred One and Forty
paise Only)
THE CAUSE OF ACCIDENT STATED IS CO-RELATES WITH DAMAGE Salvage on metal parts 10% deducted
(ssued withour Prejudice)
SURVEYOR NAME
Insurance Surveyor & Loss Assessor
