MOTOR (FINAL) SURVEY REPORT

Private & Confidential

This report is issued without prejudice, in respect of cause, nature and extent of loss/damage & subject to the
terms and conditions of the insurance policy and insurer admitting liability.
Subject:
Claim for the vehicle Reg no : KL 47 H 4858 Long Term Policy-Type
Policy Number ; 76030431181500008042 Enhancement Cover
Policy Period : 08/10/2018 to 07/10/2023
Accident dated ; 26/04/2019 @ 06.00 AM
IDV : Rs 125154/-
1. INSURER : The New India Assurance Company Limited
Irinjalakuda Branch (760304)
2nd Floor, Nakkara Complex Opp Municipal Town
Hall Irinjalakuda Kerala-680121

2. INSURED : MR.SHAKIL M S
Manalikkattil House Pullut Kerala-680663
3. H.P.A with
4. ARTICULARS OF VEHICLE:
PA
a. Registration Number : KL 47 H 4858
b. Date of Registration : 10/10/2018
c. Kilometer Reading : 5200 KMS.
d. Engine Number : G3K5E0039498
e. Chassis Number : ME1RG5218J0032916
f. Make/Model : 155 cc
g. Class of Vehicle : MOTOR CYCLE
h. Type of Body : SOLO
I. Pre accident condition : Good.
j. Un laden Weight : 135 Kgs.
k. Registered Laden Weight. : N.A
l. Tax Particulars : L.T.T. Paid.
m. Seating Capacity : 2
n. R.C. Valid up to : 15 Years from the date of Registration (08/10/2033)
o. Permit Number and Validity : N.A
p. Type of Permit & Route Area : N.A.
5. ACCIDENT DETAILS :
a. Date & Time of Accident : 26/04/2019,
b. Place of Accident : My-Bangalore Road Mandya
c. Place of Survey : M/s. Scarlet Yamaha Pvt, Ltd, JL Puram
d. Type of Survey : Final Survey
e. Date of allotment of Survey : 30/04/2019
f. Date & Time of Survey : 30/04/2019
6. PARTICULARS OF DRIVER :
a. Name of the Driver : Mr. Shakhil M S.
b. Driving License Number : 47/3752/2010
c. Date of Issue : 19/07/2010
d. Valid Up to : 18/07/2030(NT)
e. Issuing Authority : Kerala
f. Type of License : MCWG /3 WHLR/ LMV
g. Badge Number : NA
___________________________________________________________________________________
7. WHETHER THE ACCIDENT HAS BEEN
 REPORTED TO POLICE AUTHORITIES : No
a. Name of the Police Station : --
b. Date of Intimation : --
c. F.I.R. No. and Date : --
d. Details of Injuries OR damages sustained : No
e. Whether TP vehicle involved : No
__________________________________________________________________________________________
8. LOAD CHALLAN TRIP SHEET : NA
9. CAUSE AND NATURE OF ACCIDENT: As narrated in the claim form and compromise letter I.V rider hit
to the bullock Cart in My-Bangalore road near Mandya resulting in damage to the insured vehicle.
The nature of damages is relevant to the cause of accident.
Pursuant to the instruction received from M/s. NIA Claims Hub Mysore, I the undersigned Surveyor gave visit
to M/s., Scarlet Yamaha pvt Ltd, Jayalakshmi puram , inspected the I.V which was damaged due to accident,
Noted the damages and taken the necessary photographs, details as below.

EXTENT OF DAMAGES:
The following parts to be replaced front LH, RH indicators, muffler, muffler cover and fork bend to be
removed.
ASSESSMENT OF LOSS:
Assessment of Labour
Sl no. Particulars Esti Billed Assessed
1 Accidental Repairs 6500.00 3500.00 1400.00
2 Fork bend removal 480.00 480.00 280.00
3 Other Charges **** 405.00 ****
6980.00 5174.30 1680.00
Add gst @18% 302.40
1982.40

Date of registration: 10-10-2018

Date of Loss: 26-04-2019
06 months 12 days, since it is a enhancement cover policy
on metal, rubber and glass @ 0% depreciation is calculated
Assessment of parts with 0 % dep GST @ 28%
Slno Particulars Part type Est Bill Assessed

a Front LH Indicator rubber 180.00 160.00 160.00

b Front RH Indicator rubber 180.00 160.00 160.00
c Protector Muffler rubber 300.00 300.00 300.00
d Cap (muffler cover) rubber 250.00 250.00 250.00
e Cover rubber 200.00 250.00 200.00
f Cover (panel 2) rubber 150.00 150.00 150.00
g Panel 4 rubber 301.00 304.00 301.00
h Handle Bar LH metal 560.00 560.00 560.00
i Stay 1 rubber 550.00 550.00 550.00
j Panel console 1 rubber 80.00 80.00 80.00
k Panel console 2 rubber 80.00 80.00 80.00
l Clutch Lever metal 130.00 123.00 123.00
m Cover side3(H/L covel) rubber 1115.00 1040.00 1040.00
n Cover tank (tank panel) rubber 1650.00 1645.00 1645.00
o Panel comp 1(LH panel) rubber 1650.00 1723.00 1650.00
p Panel comp 2(RH panel) rubber 1650.00 1723.00 1650.00
9026.00 9098.00 8899.00
Add GST @28% 2491.72

11390.72

C. Parts @ 0% depreciation parts (18%)

a Speedo meter assy rubber 3875.00 3675.00 3675.00
b Head light assy rubber 5050.00 5050.00 5050.00
c Tail light assy rubber 1800.00 1800.0 1800.00
d RH Mirror rubber 360.00 360.00 360.00
11085.00 10885.00 10885.00
Add GST@ 18% 1959.30
12844.30
SUMMARY OF ASSESSMENT
Sl no. Particulars Esti Bill Assessed.
1 Labour Charges total 1982.40
2 Parts total 31161.00 29830.00 24235.02
26217.42
Total assessed amt 26217.42
Less Salvage 617.42
Less Policy Excess 100.00
25500.00
Net Liability 25500.00
NOTE:
1. Cause of Accident Tally to the extent of damages
2. Engine Number and Chassis Numbers are Physically Verified by me.
3. Digital Photos are enclosed.
 Bill Check Report
Insured: Mr. Shakhil MS Policy no. 76030431181500008042 Veh no KL 47 H 4858
To, Date: 21/05/2019
New India assurance company Ltd,

Description As per Sur rep As per Bill Amount Payable

A. Labour Charges allowed
Accidental repair 1400.00 3500.00 1400.00
Fork bend removal 280.00 480.00 280.00
Others charges ***** 405.00 *****
1680.00 5174.30 1680.00
Add GST@ 18% 302.40
1982.40

Spare Parts Recommended

B. Parts @ 0% depreciation parts
Front LH Indicator 160.00 160.00 160.00
Front RH Indicator 160.00 160.00 160.00
Protector Muffler 300.00 300.00 300.00
Cap (muffler cover) 250.00 250.00 250.00
Cover 200.00 250.00 200.00
Cover (panel 2) 150.00 150.00 150.00
Panel 4 301.00 304.00 301.00
Handle Bar LH 560.00 560.00 560.00
Stay 1 550.00 550.00 550.00
Panel console 1 80.00 80.00 80.00
Panel console 2 80.00 80.00 80.00
Clutch Lever 123.00 123.00 123.00
Cover side3(H/L covel) 1040.00 1040.00 1040.00
Cover tank (tank panel) 1645.00 1645.00 1645.00
Panel comp 1(LH panel) 1650.00 1723.00 1650.00
Panel comp 2(RH panel) 1650.00 1723.00 1650.00
8899.00 9098.00 8899.00
Add GST@ 28% 2491.72
11390.72

C. Parts @ 0% depreciation parts(18)

Speedo meter assy 3675.00 3675.00 3675.00
Head light assy 5050.00 5050.00 5050.00
Tail light assy 1800.00 1800.00 1800.00
RH Mirror 360.00 360.00 360.00
10885.00 10885.00 10885.00
Add GST@ 18% 1959.30
12844.30

Summary of Assessment
A. Net Labour Charges Rs 1982.40
B. Parts @ 0% depreciation Rs 11390.72
C Parts @ 0% depreciation (18%) Rs 12844.30
 Rs 26217.42
Less salvage Rs 617.42
Less compulsory deductible Rs 100.00
Rs 25500.00
Net Liability Rs 25500.00

__________________________________________________________________________________________________________________________________________________________
Note: 1. Chassis no. and Engine no. checked. 2 .Photographs enclosed 3. All the documents verified and found in order. 4. This report is released
without prejudice the liability depends on satisfying terms and conditions of the policy and submission of all necessary documents required for the
claim as prescribed by the insurer.