9045559710, 9559571425

DHEERAJ PANDEY 88, BHARDWAJI MANDI,

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

29-07-2022

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. 233900/31/2023/298 Insurance Co’s

Period of insurance 28-04-2022 to 27-04-2022 Claim No.
1. INSURERS : The Oriental Insurance Co. Ltd.,
(Address) Shahjahanpur

2. INSURED : Raghbir Singh

(Address) Vill.- Maholi Kalan, Malerkotla, Sangrur, Punjab

3. Financiers, if any : HDFC Bank Ltd.

4. VEHICLE PARTICULARS To be verified,

(a) Registration No. : PB13BP 5091
(b) Registered owner : Raghbir Singh
(c) Date of Registration : 21-04-2022
(d) Chassis No : 03255
(e) Engine No : 71739
(f) Make/Model : Tata Signa 5530.S/2022
(g) Type of body : Tractor Trailer
(h) Class of vehicle (use) : Goods Carrier
(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
: NP/PB/13/042022/80973 (Auth)
: Raghbir Singh
: 24-04-2023 (Auth)
: Permanent
: Territory of India

6- ACCIDENT
(a) Date & time of accident : 24-07-2022 at 04:00 AM
(b) Place of accident : Near Behta Gokul, Hardoi Road, Distt- Hardoi
(c) Date of survey : 24-07-2022
Contd…...2
 2

Report Dheeraj Pandey Contd…

7- DRIVER PARTICULARS To be verified,
(a) Name : Indrajeet S/O Bhupendra Singh
(b) No. : UP20 20180016183
(c) Date of issue : 31-12-2020
(d) Valid up to : 17-12-2038 (NT), 30-12-2025 (T)
(e) Issuing authority : LA Bijnor
(f) Type of license : M/Cycle + LMV Only
(g) Endorsement : Trans w. e. f. 31-12-2020

8- MISC. INFORMATIONS
(a) Passengers at the time of accident
(b) Injuries to driver/occupant
(c) Police report
(d) T.P. involvement/loss
: Two (Driver + Helper) Only
: Driver Minor Injured, Out of Danger/Nil
: Not Lodged till spot, advised to lodge the same
: No/Nil

9- LOAD BEING CARRIED : Loaded with M.S. Billets, GR to be verified/Not produced

Ex. Odisha to Punjab

10- CAUSE-NATURE OF ACCIDENT
: As told by the insured that captioned vehicle was heading
to destination side, closer to the site of accident, a rashly
driven truck came from behind & tried to overtake, in order
to save that truck said vehicle became out of control & got
overturned on its left, thus it sustained damages.

11- OBSERVATIONS

A) Registration/DL/Permit/Fitness/GR/FIR particulars to be verified/as not produced.

Chassis number physically verified.

B) Soon after having instructions from office on 24-07-2022, the undersigned made a
visit to site, Near Behta Gokul, Hardoi road and carried out the inspection, in
reported condition. The loss and circumstances were discussed with driver,
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.

LOSS SUSTAINED TO THE INSURED’S VEHICLE NO. PB13BP 5091

CABIN ASSEMBLY : L/side bent/uprooted. Cabin fr pillar/roof pressed. L/side

Bumper corner pressed. Rr structure pressed/glass broken.
L/side window glass broken. Lh door pressed/hinges bent/
door machine pressed (under impact-to be check). L/side
arch broken. Lh head lamp broken.
 Contd…...3
3

W/S GLASS : Intact

DASHBOARD : Entire structure shaken, check for joints.

COOLING SYSTEM : Radiator & other sub-assy Intact, mountings strained.

POWER SYSTEM : Engine and other sub-assy safe, mountings strained.

Air cleaner/Pressure pipes intact. Fuel tank intact.
Pneumatic tank pressed.

CHASSIS : Both longitudinal member bent.

FRONT AXLE/ DIFFERENTIAL : I-beam/Differential o.k./intact. Swivel plate bent. Hydraulic

Circuit tank box pressed (closer to cabin).

TRANSMISSION : Controlling paddles/Clutch/gear housing o.k./intact.

Propeller shaft bent. Crown to be check. Lh fr rim to be
check (sunken in soil).

STEERING SYSTEM : L/side Tie rod/Arm arm bent. Column/linkages to be check

for alignment.

SUSPENSION : L/sides main leaf spring de-cambered. R/side 2nd leaf

broken, U&C joints bent.

LOAD BODY : Entire structure/floor shaken. L/side body buldged out. All
body angles bent, joints strained.

ELECTRICAL SYSTEM : Wiring dislocated. Battery box tilted, Meter controls to be

Check.

Encl. Your’s truly

1-Fee receipt
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 RECEIPT

Bill No. OIC/11/2022 Date- 29-07-2022

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

Re: Claim Number

Policy/Cover Note Number 233900/31/2023/298
Pertaining to PB13BP 5091
A/C Raghbir Singh
Recipient GST No.
--------------------------------------------------

1. Survey fees on Spot . Rs. 850.00

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

4. DA 50% Rs. 375.00

3. Conv. 112 KM by bike @ 7.25/- (both sides) Rs. 812.00

-
----------------
TOTAL Rs. 2117.00
----------------

(DHEERAJ PANDEY)

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