SUNEET JAIN

Surveyor & Loss Assessor

CONSENT / ACCEPTANCE LETTER

TO,
THE SR DIVISIONAL / BRANCH MANAGER,
----------------------------------------------------------------------------------------------------------------DEAR SIR,
REG. : CLAIM NO..
POLICY / C.NOTE NO
INSURED .
LOSS / ACCIDENT TO.
LOSS DATED
I / WE HEREBY CONFIRM MY/OUR ACCEPTANCE TO THE FULL & FINAL SETTLEMENT OF MY/OUR ABOVE MENTIONED CLAIM TO MY/OUR ENTIRE SATISFICATION OF
RS.. AS ASSESSED BY SUNEET JAIN, SURVEYOR & LOSS ASSESSOR, JAGRAON
THE AMOUNT IS SUBJECT TO DEDUCTION SUCH AS DEPRECIATION, UNDER INSURANCE,
EXCESS/D.F CLAUSES, VALUE OF SALVAGE OR ANY OTHER APPLICABLE DEDUCTIONS &
STRICTLY SUBJECT TO ADMITTING LIABILITIES BY THE INSURERS AS PER THE TERMS &
CONDITIONS OF THE INSURANCE POLICY.
NET AMOUNT PAYABLE .
RUPEES.
BY ME/US, OTHERWISE AMOUNT OF SALVAGE (RS) MAY BE DEDUCTED
FROM THE AMOUNT OF CLAIM.
I/WE SINCERELY STATE THAT STATEMENT AND/OR INFORMATIONS GIVEN BY ME/US
VERBALLY OR IN CLAIM FROM ETC. IS TRUE AND CORRECT TO THE BEST OF MY/OUR
KNOWLEDGE & BELIEF AND NOTHING HAS BEEN CONSEALED/ MISTATED.
YOURS FAITH FULLY
[SIGNATURE OF INSURED]