C|ose

Genera| Informat|ons
Master C|a|m No : C230014032747 Ser|a| No : 1
Clalm ?ear : 2014 Clalm SLaLus : rocesslng
Department
Name
: MoLor roduct Name : 8lvA1L CA8 CCM8LPLnSlvL CLlC?
noLlflcaLlon uaLe : 12/08/2014 noLlflcaLlon 1lme : 11:07 [00:00 24Prs.]
Loss uaLe : 09/08/2014 Loss 1lme : 18:30 [00:00 24Prs.]
naLure Cf Loss :
uamage uue Lo LxLernal Means 8y
vehlcle
Loss LocaLlon : Su8A1 - Cu!A8A1
vehlcle ls ln Work : ?LS
uaLe Cf lnLlmaLlon
from Co-lnsurer
:
Cther Deta||s
Caller 1ype : uLALL8 Caller name : nA
neL Loss : 42310 Servlclng Cfflce : CALL CLn1L8
roxlmlLy uays : 331 Cover llag : ?es
name Cf nomlnee : Cashless : ?es
8emarks : veh reg no-C!-03-!L-2106 CaLasLrophe : 0
k|sk Deta||s
k|sk e|ement Sum Insured Cover Code Lst|mated amount keserve amount
vehlcle 8ase value-8aslc-Cu 487,800.00 9998 30,000.00 42,310.00
Add|t|ona| Informat|on
Ser|a| No. Deta||s Deta||s Descr|pt|on
1 urlver name 8Avln8PAl vALA8PAl kAkLC1A8
o||cy Deta||s
o||cy No : 2311200369234200000
Covernote
No]Cert|f|cate No
: 2301963043
LffecLlve lrom : 23/08/2013 LffecLlve 1o : 22/08/2014
roposa| Number : 201308290003473 roposa| Date : 29/08/2013
Insured Deta||s
lnsured name : 8Avln8PAl vALA8PAl kAkLC1A8 lnsured Address : 8-12/A 1S1 lLCC8 AvuPu1 nACA8 SCClL1?
kA1A8CAM SlnCAnC8L 8CAu kA1A8CAM
Su8A1 Su8A1 Cu!A8A1 ln - 393004
hone no : L-Mall ld. :
Moblle no. : 9823339670
Veh|c|e Deta||s
vehlcle no. : nLW--- Lnglne no. : 132240143
Chassls no. : 1066092 vehlcle Make : CLnL8AL MC1C8S
vehlcle Model : 8LA1 LndL. SLaLus : CLnL8AL MC1C8S
LndL. 8emarks : CLnL8AL MC1C8S
Workshop Deta||s
Workshop name : aLel MoLors Workshop Address :
ConLacL erson : ConLacL no. : 9823274630
A8n AccepLance : no
Lxpense Deta||s
no 8ecord lound
ayment Deta||s
no 8ecord lound
C|ose
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