Ref No.

646846 (COMMERCIAL VEHICLES INSPECTION REPORT)

Insurer/Broker. UNIVERSAL SOMPO GENERAL Proposer. SHAHJEB Ins. Comp Ref No Us
INSURANCE CO. LTD.

Officer/Agent Name. NIC Tel No. 9319960226 Request Date 01/03/2019 Time 03:16 PM
(INSPECTION DETAILS)
Date 01/03/2019 Time 03:27 PM Place BULANDSHAHAR
BODY PARTS DESCRIPTION VEHICLE DETAILS
Cowl Safe Vehicle no. UP13AT5570
DashBoard Safe Chassis no. 3F14750
Bonnet Safe Engine no. 3601782
Grill Safe Make TATA MOTORS
Bumper Safe Model 3718
Cabin safe Odo Meter 149162
Body safe Colour NA
Bus Left Side Body NA Year of Manufacture 2017
Bus Right Side Body NA R.C. Verified Yes
Head Lights Safe Fuel Used Diesel
Indicator Lights Safe
W/S Glass Safe
Extra Fittings
Bus Window Glasses L/s NA
NA
Bus Window Glasses R/s NA
Back Glass NA
Rear View Mirrors Safe
Excavator Cabin Glass NA
Crane Cabin Glass NA
Front Excavator NA MARKET VALUE ON THE DATE OF INSPECTION(In INR)
Crane Bucket NA NA
Crane Hook NA
Boom NA INSPECTION STATUS
Ac NA Recommended
Fans NA
Hydrualic System NA
Chassis Frame Safe Remark RC SEEN
Fuel Tank Safe
Left Door Safe
Right Door Safe
Seats Safe
Tyres Average
Stepny Average
Chassis Production No. -
Type of Body Truck
Stero Make NA
Extra Fittings/Remarks NA
Market value NA

Declaration Of Owners
I/We hereby confirm that the vehicle has been inspected in presence of me/my/our representative.
I/We hereby confirm that the identification details and damages of vehicle as noted/photographs taken by the inspecting officer are correct. Nothing has been
hidden/undisclosed.
I/We agreed that Repair/Replacement of dented/crack parts & Repair Painting of dented/scratched panels as per this inspection photographs shall be excluded in event of
any claim lodged during the policy period.
I here certify that I have shown the same vehicle which I have to get insured and if later at the time of claim it is found that vehicle shown and accidental are different then
no claim is payble to me.
I here certify that I will not claim for damages existing in my vehicle whether same are mentioned in report or not if same are seen in photograph taken by the inspector.
Executive Name :- Paritosh Customer Signature

QC Done By :- Lalitpal

Corporate Office: 802-804, 8TH FLOOR,VIJAYA BUILDING, BARAKHAMBHA ROAD,NEW DELHI 110001. Regional Centre: Meerut

Declaration:-This is computer generated report and not required any signature.