Anda di halaman 1dari 9

ILA Format

Surveyor Name DHEERAJ SOOD


Location City, State
Surveyor Mobile number 9810111421
Surveyor mail id dhsood@gmail.com
Claim no 0
Policy number 0
Insured name 0
Vehicle no 0
Make & Model 0
IDV 0
Driver name & validity of DL MR.
Place of accident with State 0

Cause of accident 0

Date of survey 30/Dec/99


Reserve Amount
Mode of settlement Repair/CTL/Cashloss
Rapairer Name & Number 0
Cashless / Non Cashless

Pending Documents

Discrepancy Noted (if any)

Technical approval required


(Major assemblies)
DHEERAJ SOOD
DB-2B HARI NAGAR, NEW DELHI-110064 SLA - 41033 Expiry - 18-May-2018
Mobile - 9810111421 Email ID - dhsood@gmail.com

MOTOR SURVEY REPORT - FINAL


Report no. Date 27-Mar-17
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.
INSURANCE PARTICULARS
INSURER : SBI GENERAL INSURANCE COMPANY CLAIM NO.
INSURED :
POLICY/C.N. NO : From 31-Jul-16 to
HYPOTHECATION, IF ANY : -- IDV Rs. only
VEHICLE PARTICULARS RC particulars VERIFIED
REGISTRATION NO. :
REGISTERED OWNER :
DATE OF REGISTRATION : Pre accident condition - OK
ENGINE NO. : Physically Verified
CHASSIS NO. : Physically Verified
MAKE/MODEL : COLOR - DIAMOND WHIT CC -
CLASS OF VEHICLE : ODOMETER - Kms
TAX PAID UPTO :
REG LADEN WEIGHT : UNLADEN WEIGHT -
FITNESS CERTIFICATE NO. : VALID UPTO -
PERMIT NO. : VALID UPTO -
TYPE OF PERMIT :
AREA OF OPERATION :
DRIVER PARTICULARS DL particulars VERIFIED
NAME OF DRIVER : MR. NEERAJ TOKAS
DRIVING LICENSE NO. :
DATE OF ISSUE :
VALID UP TO : FOR TRANSPORT -
ISSUING AUTHORITY :
VEHICLE AUTHORIZE TO DRIVE :
BADGE NO. : -
ACCIDENT PARTICULARS
DATE & TIME OF ACCIDENT : AT 19.00 PM
PLACE OF ACCIDENT : STATE - DELHI
SURVEY ALLOTMENT DATE : FINAL SURVEY DATE -
RE INSPECTION DATE :
REPAIRER'S NAME :
THIRD PARTY PARTICULARS : NA
REPORTED TO POLICE : NO FIR no.__________ Police Station ___________________
SPOT SURVEY & LOAD CHALLAN
SPOT CARRIED OUT :
DETAILS OF LOAD CHALLAN :
WEIGHT CARRIED : Load carried as per limit YES NO
CAUSE OF ACCIDENT

SPECIAL COMMENTS

1 PAYMENT TO WORKSHOP

DHEERAJ SOOD
SURVEYOR & LOSS ASSESSOR
Motor Claim Assessment Sheet - SBI General Insurance
Claim no 0 Vehicle No 0 Insured Name 0
Reg. Date 30-Dec-99 Date of Loss 30-Dec-99 Garage name 0
GST L % 18.00% S Tax Credit Amt - Paint Mat_Bifurcated No Age of Vehicle -
GST P % 28.00% Report Date 27-Mar-17 Labour % 100 Depreciation 0

Labour Cost
Assessed Labour Taxes
S No Part Name Work Type Painting Paint Total
R/R Repair GST % Amount Other Tax % Amount
Labour Bifurcated
1 - 18.00% 0 0.00% 0 -
2 - 18.00% 0 0 -
3 - 18.00% 0 0 -
4 - 18.00% 0 0 -
5 - 18.00% 0 0 -
6 - 18.00% 0 0 -
7 - 18.00% 0 0 -
8 - 18.00% 0 0 -
9 - 18.00% 0 0 -
10 - 18.00% 0 0 -
Total - - - - - - - -

Assessed Parts
Cost without Other Tax
S No Part Name Part Desc Part Type GST % GST Amt Amt Total
tax %
1 28.00% - 0 -
2 28.00% - 0 -
3 28.00% - 0 -
4 28.00% - 0 -
5 28.00% - 0 -
6 28.00% - 0 -
7 28.00% - 0 -
8 28.00% - 0 -
9 28.00% - 0 -
10 28.00% - 0 -
- 0 -
Total - - 0 -

Summary of Parts
GST LAB GST L & P Other Tax
S No Part Type Parts Other Tax Total Parts Dep % Dep Amt Net Parts
& PARTS Amt amt
1 Metal - - - - 0 - -
2 Plastic - - - - 50 - -
3 Fibre - - - - 30 - -
4 Glass - - - - 0 - -
Paint Material
5 - - - - - - 50 - -
Total - - -
Remarks
Liabilty Computation 1.
2.
Net parts -
3.
Net labor -
Total -
Add: Dep reimbursed NO 0.00
Add: Towing Amt -
Less: Comp. Excess 1,000.00
Less: Add/Voluntary Excess -
Less: Dep . On paint @ 28% on Paint labour -
Less: Salvage if Any - Payment to: Popular Vehicles
Final Liabilty Rs. -1000 Surveyor name & seal : DHEERAJ SOOD
DO / Liability Letter

Date: 3/27/2017
To,

Insured Name : 0
Policy No : 0
Vehicle Regn No : 0
Make & Model : 0
Claim No : 0
Date of Accident : 12/30/1899

With reference to the above claim details, our liability towards the Claim no. 0
is as below. Request you to deliver the vehicle by collecting difference amount
& without deducting salvage amount to Insured.(If Insured is not carrying the salvage)

Invoice Amount -
Invoice Date
Policy Excess 1000
Claim Approved
-1,000
For
Insured’s
1,000
Liability

Note: -

Salvage amt of Rs. 0 will be deducted from dealer payment if salvage is


retained by dealership.

Please collect following documents for further payment process.


1
2
3

We shall release the payment within 5 working days (if claim amount is <50K)/
7 working days (if claim amount >50K) from the date of receipt of last document.

Thanks & Regard

DHEERAJ SOOD
SURVEY FEE BILL TAX INVOICE DATE 27

DHEERAJ SOOD
SURVEYOR & LOSS ASSESSOR EA-415, MAYA ENCLAVE, HARI NAGAR
SLA- 41033 NEW DELHI-110064
GSTIN No. 07AQDPS5699G1Z8 MOBILE NO 9810111421, 011-25133720
PAN NO : AQDPS5699G

BILLING ADDRESS
SBI GENERAL INSURANCE CO. LTD
7B, Ground Floor, Rajendra Park, Pusa Road
New Delhi-110060
GST No. 07AAMCS8857L1ZE

Place of Supply : DELHI

INVOICE NO. DS/SR/17-18/1486 HSN CODE 99712

CONV
CHARGE TAXABL
S NO ITEM DES SAC COD FEE S E VALUE CGST SGST

INSURAN
CE
CLAIM
ADJUST
MENT
SERVICE
S 997162 RATE % AMT RATE %
CE
COMPAN
INSURED Y
CLAIM NO0
Mohd
POL NO. Asif
s
VERIFIE
VEH. NO D

PROFESSIONAL FEE 1100 250 1350 9 121.5 9


REINSPECTION FEE 0 250 250 9 22.5 9
OTHERS(CD CHARG 50 0 50 9 4.5 9

TOTAL 1150 500 1650 148.5

TOTAL INVOICE VALUE IN FIGURE 1947


TOTAL INVOICE VALUE IN WORDS Rs. One Thousand Nine Hundred Fourty Seven Onl

DHEERAJ SOOD
SURVEYOR AND LOSS ASSESSOR
DATE 27/10/2017

CLAVE, HARI NAGAR

11421, 011-25133720

SGST IGST

AMT RATE % AMT

121.5 0 0
22.5 0 0
4.5 0 0

148.5 0 0
Hundred Fourty Seven Only

SS ASSESSOR

Anda mungkin juga menyukai