Dinesh Kumar Katiyar
Automobiles Engineer (I.I.I.S.L.A) Fellow membership no. F/N/03195, Approved surveyor, Loss Assessor, Investigator & Valuer
License no. S.L.A. 17991 Date of expiry 9/02/2024 Valuer Lic. No. L-13821
Pan Card No. ALVPK5767E GSTIN - 09ALVPK5767E1ZF
Bank Account No. 06792010010390-OBC (IFSC CODE- PUNB-0067910)
E.Mail at – [email protected]
Ref:-D.K.K./23-24
Vehicle No: - UP 25 CD 8562 Date- 16.03.2023
Job assigned on: -
FINAL
[MOTOR 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 policy.
Cover Note / Policy No: - 0805023122P107097741
1. Insurers : Divisional Office - United India Insurance Co. Ltd.
2. Insured Name : Mr.Sahil Gupta S/o Mr.Ram Bhole Gupta
(a) Insured Address : R/o 73 A Bannu Bal Nagar,Bareilly
(b) Insured Mobile No. : 8273335899
_________________________________________________________________________________________
3. Policy Details
(a) Policy No. : 0805023122P107097741
(b) Policy Period : 22.10.2022 to 21.10.2023
(c) Is Break In Insurance Case ? : YES/NO - NO (Enclosed PI Report if Break In Case)
(d) Is Close Proximate Case ? : YES/NO - NO
4. Financiers : Nil
5. (a) Date &Time of Accident : 02.02.2023 at 08:00 P.M
(b) Place of Accident : Near Jalalabad to Katra Road
(c) Date of Intimation : 03.02.2023
(d) Place of Survey : Aryan Motors, Bareilly.
(e) Date of Survey : 07.02.2023 & onwards.
6. R.C.Particulars Verified from the original (Online Verified copy enclosed)
(a) Registered owner name & address. : Mr. Sahil Gupta S/o Mr.Ram Bhole Gupta
: R/o 73 A Bannubal Nagar Bareilly
(b) Registered no. : UP 25 CD 8562
(d) Chassis no. (Physically Verified) : MALA651ELHM743868
(e) Engine no. (Physically Verified) : D3FBHM460229
(f) Make and model. : Hyundai Motor India Ltd/Grand I 10/11.2017
(g) Registered laden weight. : 1500 Kgs
(h) Unladen weight. : 1050 Kgs
(i) GVW : NA
(j) Passenger carrying capacity. : 5 in all
(k) Fitness certificate no. /up to. : 16.03.2033
Office Cum Resi :Surabhi Colony Civil Lines South, PILIBHIT-262001(uttar Pradesh)
Resi : 05882 -255356 Mobile : 94122 96201
Dinesh Kumar Katiyar
Automobiles Engineer (I.I.I.S.L.A) Fellow membership no. F/N/03195, Approved surveyor, Loss Assessor, Investigator & Valuer
License no. S.L.A. 17991 Date of expiry 9/02/2024 Valuer Lic. No. L-13821
Pan Card No. ALVPK5767E GSTIN - 09ALVPK5767E1ZF
Bank Account No. 06792010010390-OBC (IFSC CODE- PUNB-0067910)
E.Mail at – [email protected]
Ref:-D.K.K./23-24
(l) Road tax validity up to. : Life Time
(m) Pre-accidental condition. : NA
________________________________________________________________________________________
7. Driver’s Particulars Valid as on date of loss and verified from the original.
(Online Verified copy enclosed)
(a) Names & Father’s Name of Driver
: Mr.Sahil Gupta S/o Mr.Ram Bhole Gupta
R/o 73 A Bannubal Nagar 3 Bareilly
(b) Licence No. : UP 2520190018439
(c) Date of Issue : 21.08.2019 Date of Birth:-15.01.2001
(d) Validity : 20.08.2039
(e) Issuing Authority : Bareilly
(f) Type of license : For MCWG & LMV only
(g) Badge No. : NA
(h) Endorse of license : Nil.
________________________________________________________________________________________
8. PERMIT DETAILS. NA.
(a) Name on permit. :
(b) Vehicle no. :
(c) Permit no. & validity. :
(d) Permit Authorization no. & Validity :
(e) Route/area. :
(f) Passenger/load carrying capacity. :
8. Goods tax/passenger tax NA.
9. DETAILS OF LOAD CHALLAN. NA.
11. (a) Own Passengers & Driver Injuries(if any) :
(b) Number of own passengers :
(c) The accident has been reported to police :
(d) Station Dairy No. / FIR No. :
12. (a) Was third party involved in the accident :
(b) Full details of fatal /non fatal injuries and :
Damages to the third party/property.
13. Cause and Nature of Accident. (As per insured’s narration written in the claim-form).
The Subject i.v. was on its way Bareilly from Jalalabad, near the place of accident it was very
dark and due to bad road hazards. The vehicle lost control & want in to a deep pit received the
under garage damages, causing damages.
Office Cum Resi :Surabhi Colony Civil Lines South, PILIBHIT-262001(uttar Pradesh)
Resi : 05882 -255356 Mobile : 94122 96201
Dinesh Kumar Katiyar
Automobiles Engineer (I.I.I.S.L.A) Fellow membership no. F/N/03195, Approved surveyor, Loss Assessor, Investigator & Valuer
License no. S.L.A. 17991 Date of expiry 9/02/2024 Valuer Lic. No. L-13821
Pan Card No. ALVPK5767E GSTIN - 09ALVPK5767E1ZF
Bank Account No. 06792010010390-OBC (IFSC CODE- PUNB-0067910)
E.Mail at – [email protected]
Ref:-D.K.K./23-24
Keeping in view the circumstances of the accident, the losses assessed may occur in the vehicle
in such type of accident.
RECOMMENDATION-A net loss of Rs. 47430.66 only (Rs. Forty Seven Thousand Four Hundred & Thirty Rupees & Sixty Six Paisa
only.) is hereby assessed and recommended to paid to the Insured as per the terms and conditions of the policy.
RE-INSPECTION-The undersigned carried out the re-inspection and all the repairs and replacements were confirmed by the undersigned.
D.K Katiyar
Surveyor
Office Cum Resi :Surabhi Colony Civil Lines South, PILIBHIT-262001(uttar Pradesh)
Resi : 05882 -255356 Mobile : 94122 96201
