Volkswagen Car Survey

Car Survey Form - ICICI LOMBARD

*Required

1. Email address *

2. Date of Survey:
Place of Survey:

Example: 7 January 2019, 11.03 a.m.

3. Marks & Numbers *

Chassis No and Engine No. of the Vehicle

Mark only one oval per row.

Vehicle Details

Chassis No.

Engine No.

Year of Mfg:
4. Details of Survey *

Mark only one oval per row.

Is Engine Damaged? Give Nature of

Damages

Is Chassis Damaged? Give Nature of

Damages

Is Transmission Damaged? Give Nature of

Damages

Is Quarter Panel Damaged? Near Boot of Car

(part of Chassis) both Sides

Is Rocker Panel Damaged? Bottom Most

panel of car (part of chassis)

Is Roof Damaged? Part of Chassis

Is A, B, C, Pillar Damage? All 6 columns

welded to Chassis (part of chassis)

Is Front End Chassis Bracket

Damaged? Near Radiator - Both sides front
of car under hood

Are there dents and scratches? Give details

CHECKLIST REFERENCE

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