FINAL SURVEY REPORT Report Date :Monday 08-June -2020 Insured Details Claim Number OC-21-1103-1801-00000693 Policy Number OG-20-9910-1801-00011295 Policy Inception Date 28-JUN-2019 Policy Expiry Date 27-JUN-2020 Customer Name PRABHAKAR DUBEY Vehicle Reg. Number DL9CAQ2706 Telephone No 9717002770 Mobile Number 9811806608 Customer Address KG-2/336 2ND FLORR VIKASPURI VIKAS PURI TILAK NAGAR WEST DELHI NEW DELHI 110018110018 Repairer Name NON TIEUP REPAIRER Vehicle Information Registration No DL9CAQ2706 Vehicle Reg.Date 28-JUN-2018 Make MARUTI Model CELERIO Chassis No MA3ETDE1S00529433 Engine Number 0000008091115 Vehicle Register As Private Car Cubic Capacity 998 Manufacture Year 2018 Color Metallic Hypothecation NA RTO Endorsement LMVNT Odometer Reading 34362 Driver Details Vehicle Parked No Relation With PHI Self Driver Name PRABHAKAR DUBEY Driving License No Br2420110005618 Date of Issue 01-APR-2011 Date of Expiry 31-MAR-2031 MDL Issuing Authority rohtas DL Endorsement LMVNT Driving License Type Permanent Loss and Survey Information Date of Loss 01-JUN-2020 Intimation Date Claim Registration Date 02-JUN-2020 Date of Survey Allot- 03-JUN-2020 ment Date of Survey 08-JUN-2020 Survey Report Status FSR Generated Description of Loss As for ciaim - IV was parked when a truck hit IV Surveyor Comments RHS Frontal damages correlating allowed Fender and FR Bumper allowed. Insured has claimed fr RH upper side body, Q/Panel and Rear Door are not correlating hence disallowed Ifurveyor Signaturel Auth. BAGIC Signature Report Issued without prejudice subject to policy terms and conditions. Report Printed On : 08-06-2020 05:07:24 --------------PAGE END----------------------- Claim No : OC-21-1103-1801-00000693 Registration No : DL9CAQ2706 Printed On :08-JUN-2020 Approval(Annexure-1) Parts Report Claim Id : 19124956 QTY Retail Total Net Net Depr Net As- Benefit Price Amount Tax Amt Amt sessed Flag Amt Total Parts Amount 0 0 0 0 0 Labour Details Claim Id : 19124956 Allowed Net Tax WCT Assessed Paint Remarks Amt Depr Painting FRONT BUMPER 2500 450 0 2581.25 368.75 S3 FENDER FRONT RHS 2000 360 0 2065 295 S3 4500 810 0 4646.25 663.75 Total Labour Amount 4500 810 0 4646.25 663.75 Total Assessed Amount Parts : :0 Total Assessed Amount Labour : :4646 Salvage Amount(On Parts) @ :0 Towing Charges :0 Compulsary Excess :1000 Voluntary Excess :0 Addl/Imposed Excess : :0 depreciation Amount 664 S3 - Depreciation : 664 Nett Assessed Amount (Parts Labour). 4310 R * E 10h Surveyor Signature Auth. BAGIC Signature --------------PAGE END----------------------- PANKAJKALRA SURVEYOR AND LOSS ASSESSOR License NumberIRDA/IND/SLA-73833 Mobile: +91 9560711136 Valid up to:25-12-2021 E-mail: pankajkalra41@yahoo.in PAN No.:AREPK8637N GST No.: 07AREPK8637N1Z6 Surveyor Fees Bill To, Bill No. BAZ/20-21/28 Date 08-06-2020 Bajaj Allianz General Insurance Company Limited Block No-4,7th Floor,DLF Tower,Shivaji Marg,New Delhi 110015. Phone-011-66278000 GST No.07AABCB5730G1ZZ Claim No. OC-21-1103-1801-00000693 Vehicle No. DL9CAQ2706 Policy No. OG-20-9910-1801-00011295 Insured Name PRABHAKAR DUBEY Professional Fee 500.00 Conveyance Final Survey 150.00 CGST @ 9% 58.50 SGST @ 9% 58.50 Total INR Incl. Tax 767.00 Rs. Seven Hundred and Sixty Seven Only. --------------PAGE END-----------------------