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MBD Survey Report Format

This document is a machinery breakdown survey report submitted by a surveyor to an insurance company. [1] It provides details of a machinery breakdown that occurred at a insured premises along with the claim details submitted by the insured. [2] The surveyor inspected the failed machinery and found the claim to be admissible. [3] The surveyor assessed the claim amount payable to be Rs. XX and enclosed relevant documents with the report.

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7K views3 pages

MBD Survey Report Format

This document is a machinery breakdown survey report submitted by a surveyor to an insurance company. [1] It provides details of a machinery breakdown that occurred at a insured premises along with the claim details submitted by the insured. [2] The surveyor inspected the failed machinery and found the claim to be admissible. [3] The surveyor assessed the claim amount payable to be Rs. XX and enclosed relevant documents with the report.

Uploaded by

abhinav_surveyor1355
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
  • Policy and Insured Details
  • Breakdown Details and Observation
  • Damage Assessment and Surveyor's Report

- Surveyor name - address - Communication address Surveyor Ref: / MBD / Date:

MACHINERY BREAK DOWN SURVEY REPORT


(This report is issued with out prejudice in respect of cause nature and extent of loss / damage and subject to the terms and conditions of the Insurance policy.)

PARTICULARS INSURANCE POLICY

Name of the insurer Name of the insured Policy number Period of insurance Type of policy Premises / works address Item insured as per policy Total sum insured Total premium charged Failed item covered in policy Sum insured for failed machine Initial policy excess

: : : : : : : : : : : : : : : : : : : : : : : Schedule serial number : Machinery break down

DETAILS BREAK DOWN SURVEY PARTICULARS

Date of break down Time of break down Witness of the occurrence Place of occurrence Repair work attended by Amount claimed by the insured Survey work appointed by Date of appointment Date of survey Place of survey Person present during survey

Purchase invoice particulars Details of guarantee period Function of the machine

: : :

- Surveyor name - address - Communication address DETAILS OF FAILED UNIT

Details of log book Name plate details Details of damage

: : :

INTREST INSURABLE SUM INSURED ADEQUACY OF

On verification of records produced by the insured, I came to know that the said failed Machine was owned by the insured and hence the insured has insurable interest in the here mentioned machine.

Insured value of the machine failed machine Present cost of the new machine New machine quotation received from Remarks

: : : :

Rs. Rs. M/s.

RISK ABOUT THE ABOUT LIFE / OF LOSS CAUSE

It was informed that there was no major loss / damage in the past. The said machine is operated and maintained as per the recommendation of OE manufacture.

- Surveyor name - address - Communication address ABOUT SALVAGE DEPRECIAIOON LOSS ASSESSMENT

The sudden, unforeseen physical loss / damage to the insured property had occurred during the period of insurance and due to a peril not excluded in the policy. There is no breach of warranty nor willful act / negligence on the part of insured. Hence, in my opinion the claim is admissible. I have given below my assessment.
SL No Particulars Qty Estimate Assessed

SURVEYOR COMMENTS SIGNATURE

Serial number of the failed machine was verified physically and found in order with policy copy. The sum insured for the damaged property is adequate. I have disallowed the Labour charges for replacement of parts since the machine was under AMC with M/s. The claim is admissible. In my opinion amount payable to the insured is Rs. I have received the claim papers from the insured on The repaired unit was inspected by me on XX.XX.XXXX . Copy of invoice and payment details were collected and enclosed for your reference.

Surveyor.
ENCLOSURES

Survey bill Claim intimation letter Estimate Witness statement Final bill with payment details

Photos taken by me Claim form Policy copy

XX

Nos.

New machine quotationto check adequacy of insurance Test report after completion of repair work.

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