9045559710, 9559571425

DHEERAJ PANDEY 88, BHARDWAJI MANDI,

Govt. Approved Surveyor MUNNU GANJ PHATAK
(SLA 121928 Validity 12 Jan. 2024) dheeraj2228889@gmail.com Shahjahanpur - 242001

28-06-2022

MOTOR SURVEY REPORT (SPOT)

This report is issued by me as licensed Surveyor without prejudice, in respect of cause, nature and
extent of loss/damages and subject to the terms and conditions of the Insurance Policy:

Policy No. 221401/31/2022/2933 Insurance Co’s

Period of insurance 13-11-2021 to 12-11-022 Claim No.
1. INSURERS : The Oriental Insurance Co. Ltd.,
(Address) Shahjahanpur

2. INSURED : Intezar Ali

(Address) 85/386 Dilazak Cantt. Shahjahanpur

3. Financiers, if any : Cholamandalam Invest. & Finance Co. Ltd., Shahjahanpur

4. VEHICLE PARTICULARS To be verified,

(a) Registration No. : UP27AT 1515
(b) Registered owner : Intezar Ali
(c) Date of Registration : 12-11-2020
(d) Chassis No : 04433
(e) Engine No : 01362
(f) Make/Model : Tata LPO 1618/2020
(g) Type of body : PCV
(h) Class of vehicle (use) : Bus
(j) Pre-accident condition : Satisfactory
(k) Registered laden weight :}
(l) Un-laden weight :}
(m) Fitness No./Validity : } To be verified
(n) Seating capacity :}
(o) Road tax paid up to :}

5- PERMIT PARTICULARS To be verified,

(a) Permit No :
(b) Name of holder :
(c) Valid up to :
(d) Type of permit :
(e) Area of operation :

6- ACCIDENT
(a) Date & time of accident : 19-06-2022 at 10:00 pm
(b) Place of accident : Near Gurri Chowki, NH- 24, Shahjahanpur
(c) Date of survey : 21-06-2022
Contd…...2
 2

Report Dheeraj Pandey Contd…

7- DRIVER PARTICULARS To be verified,
(a) Name : Mahesh S/O Natthu Lal
(b) No. : UP27 20110005969
(c) Date of issue : 13-10-2021
(d) Valid up to : 12-10-2031 (NT), 12-10-2026 (T)
(e) Issuing authority : LA Shahjahanpur
(f) Type of license : LMV + M/Cycle Only
(g) Endorsement : Trans w. e. f. 27-11-2014

8- MISC. INFORMATIONS
(a) Passengers at the time of accident
(b) Injuries to driver/occupant
(c) Police report
(d) T.P. involvement/loss
: Driver & Conductor + 35 Passengers Only
: No/Two Passengers minor injured, out of danger.
: Lodged at PS- Roza, Shahjahanpur, Copy to be obtained.
: No/Nil

9- PASSENGER BEING CARRIED : There were 35 passengers on board

Way bill not produced/To be verified
Ex. Gonda to Ludhiana

10- CAUSE-NATURE OF ACCIDENT
: As told by the insured that captioned vehicle was heading
to destination side, closer to the site of accident, due to high
beam light of an incoming vehicle driver failed to check, ran
over the heap of soil, became unbalanced & got overturned
on its L/side and thus it sustained damages.

11- OBSERVATIONS

A) Registration/DL/Permit/FIR/Way bill particulars to be verified, Chassis number

physically verified.

B) Soon after having instructions from office on 21-06-2022, the undersigned made a
visit to site, Near Gurri Chowki, NH- 24 Sitapur road at Shahjahanpur and carried
out the inspection, in reported condition. The loss and circumstances were
discussed with insured, necessary photographs were also arranged to visualize the
extent of damages, which are self explanatory, enclosed herewith.

C) After weighing all sort of evidences/physical verification of damages, I opine that

questioned vehicle sustained accidental damages, resultant to reported
circumstances and also looking very fresh.

D) Soon after accident local police/administration reached at site, provided help to

injured & in a process of evacuation took the vehicle from site, later on police took
the said vehicle under his custody & shifted to Gurri Chowki, PS- Roza, where I
did the survey.

Contd….3
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LOSS SUSTAINED TO THE INSURED’S VEHICLE NO. UP27AT 1515

1- Front W/S glass broken, both outer rear view mirror broken/arm pressed. Fr Bumper
pressed/grill broken. Both sides bumper light broken. L/side head light broken. L/side
RVM broken. Fr show/grill heavily pressed/smashed. Roof lining pressed-torn. Floor
channels/re-enforcement pressed/crushed, roof pressed. L/side door pressed-hinges
bent/both door glass (up & down)/quarter glass/upper tile glass broken. L/side both
window glass (upper & Lower) broken. L/side passenger window glass at upper side No.
1, 3 & 5 broken. L/side passenger window glass at lower side No. 1 & 2 broken. R/side
door pressed-hinges bent. Both R/side door glass/quarter glass/upper tile glass broken,
RVM intact. Dashboard heavily pressed at left, all joint strained.

2- Entire body shaken, angles bent, joints strained, MS sheet at both sides/tail/pillar
pressed. Seating structure upsets, seat frame bent. The entire left side found bend/angle
window frame bent, channels bent/pressed. Inner sheet pressed. Roof mica cracked.
Fr & rear L wheel sides body outer sheet pressed.

3- Chassis left member, X- member bent, loss is to be ascertained during final.

4- Wiring dislocated. Battery not found, removed just after accident. Terminal damaged
(photographs arranged by insured, enclosed), to be check at final survey.

5- Engine foundation strained. Radiator damaged/hose pipes pressed.

6- Front L/S main leaf bent, U&C bolts bent.

7- Steering linkages/arm to be checked for alignment.

Encl. Your’s truly

1-Fees bill
2-Photographs - 08 digital

(DHEERAJ PANDEY)
 9045559710, 9559571425
DHEERAJ PANDEY 88, BHARDWAJI MANDI,
Govt. Approved Surveyor MUNNU GANJ PHATAK
(SLA 121928 Validity 12 Jan. 2024) dheeraj2228889@gmail.com Shahjahanpur - 242001

FEE BILL
Bill No. OIC/9/2022 Date- 29-06-2022

To,
The Manager
……………………………………………
The Oriental Insurance Co. Ltd.
……………………………………………
Shahjahanpur
……………………………………………

Re: Claim Number

Policy/Cover Note Number 221401/31/2022/2933
Pertaining to UP27AT 1515
A/C Intezar Ali
Recipient GST No.
--------------------------------------------------

1. Survey fees on Spot . Rs. 850.00

2. Photographs 08 No. @10/- Rs. 80.00

3. Conv. 34 KM by bike @ 7.25/- (both sides) Rs. 246.00

4. DA 30% Rs. 250.00

----------------
TOTAL Rs. 1426.00
----------------

(DHEERAJ PANDEY)

_____________________________________________________________________________________
PAN NUMBER CQAPP6081J, A/C No. 20070091746, SBI CHOWK MANDI
MICR 242002004, IFSC SBIN0004000