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Motor Claim Intimation: Reason For Late Intimation: (If Intimate After 7 Days of Accident)

This document is a motor claim intimation form that collects key details about an insured, their policy, vehicle, accident, and estimated loss. It requests the name and contact of the insured, policy number and period, vehicle make and model, date and location of the accident, driver information, estimated loss amount, intended repair workshop, and reason for late reporting if after 7 days.

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vraj shah
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263 views1 page

Motor Claim Intimation: Reason For Late Intimation: (If Intimate After 7 Days of Accident)

This document is a motor claim intimation form that collects key details about an insured, their policy, vehicle, accident, and estimated loss. It requests the name and contact of the insured, policy number and period, vehicle make and model, date and location of the accident, driver information, estimated loss amount, intended repair workshop, and reason for late reporting if after 7 days.

Uploaded by

vraj shah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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MOTOR 

CLAIM  INTIMATION 

1  Name of Insured    
        
2  Insured  Contact Number    
        
3  Policy Number:    
    Policy period:     
4  Vehicle Number    
        
5  VEHICLE MAKE & MODEL    
        
6  Date of Accident    
    Reason For Late Intimation: (If Intimate after 7 days of accident)    
7  Place of Accident    
    SPOT SURVEYOR NAME and No.:    
8  Name of Driver    
        
9  Driving License Number:                                                              
    Driving License validity:    
10  Detail of Any Injury:                                                                              
    FIR:    
11  Estimated Loss &                                                                                   
    IDV:    
12  Name & Location of The Workshop:    
        
13  Workshop Contact No.    
 

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