OMAN UNITED INSURANCE CO. S.A.O.G.

Survey Yard
Report ID: PGIBC0711 Run on: 24-01-24 09:28 AM

Claim No. : C-1000-96-2024-00009 TP Excess R.O: 50 Excess NOT PAID (D.N)

Regn No. : 9487DY Make: B.M.W. X5 Year : 2019

Customer Name: MR, RAGHAVAN RAJESH Contact No.: 90698248 Prepared by:SAUD_D

H.O. Remarks:

VIR 2024/11684

Received Date Received Time Received by K.M. Break Down

Key Remarks: In Yard

Spare Wheel
With Customer
Jack
Tools
Wheek Spanner
Wipers
C/Lighter
Radio/CD Player
Antenna
A/C
Wind Screen
Wheel Caps No.
FUEL

I hereby authorize you to do the necessary repair and
grant your employees to drive the vehicle inside and
outside the workshop.
I confirm that I have removed all valiable items and
cash from the vehicle.
Vehicle has to be collected wuthin one week of
delivery notice, failing to do so will result in a R.O. 5/
charge per day for parking.
Repairing the vehicle is subject to spare availability,
OUIC will not be liable for non availability of spare parts
‫ﺃﻓﻮﺿﻜﻢ ﺑﻤﻮﺟﺐ ﻫﺬﻩ ﺍﻻﺳﺘﻤﺎﺭﺓ ﻟﻌﻤﻞ ﻣﺎ ﻳﻠﺰﻡ ﻧﺤﻮ ﺍﻻﺻﻼﺡ ﻓﻲ ﺃﻱ ﻭﺭﺷﺔ‬
‫ﺗﺤﺪﺩﻫﺎ ﺍﻟﺸﺮﻛﺔ ﻭﺃﻣﻨﺤﻜﻢ ﺗﺼﺮﻳﺤﺖ ﻟﻘﻴﺎﺩﺓ ﺍﻟﻤﺮﻛﺒﺔ ﺩﺍﺧﻞ ﻭﺧﺎﺭﺝ ﺍﻟﻮﺭﺷﺔ‬
‫ﺃﻗﺮ ﻭﺃﻭﻛﺪ ﺑﺄﻧﻨﻲ ﻟﻢ ﺃﺗﺮﻙ ﻓﻲ ﻣﺮﻛﺒﺘﻲ ﺃﻳﺔ ﺃﺷﻴﺎﺀ ﺛﻤﻴﻨﺔ ﺃﻭ ﻧﻘﻮﺩ‬
‫ﺃﺗﻌﻬﺪ ﺑﺄﺳﺘﻼﻡ ﺍﻟﻤﺮﻛﺒﺔ ﻋﻨﺪ ﺇﺑﻼﻏﻲ ﺑﺈﻧﺘﻬﺎﺀ ﺍﻻﺻﻼﺣﺎﺕ ﻭﻓﻲ ﺣﺎﻟﺔ ﻋﺪﻡ‬
‫ﺍﺳﺘﻼﻣﻬﺎ ﺧﻼﻝ ﺃﺳﺒﻮﻉ ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻻﺑﻼﻍ ﻓﺄﻧﻨﻲ ﺳﺄﺗﺤﻤﻞ ﺗﻜﺎﻟﻴﻒ ﻭﻗﻮﻑ‬
‫ ﺭﻳﺎﻻﺕ ﻋﻤﺎﻧﻴﺔ ﻋﻦ ﻛﻞ ﻳﻮﻡ ﺗﺄﺧﻴﺮ‬٥ ‫ﺍﻟﻤﺮﻛﺒﺔ ﺑﻮﺍﻗﻊ‬
‫ﻋﻤﻠﻴﺔ ﺍﻻﺻﻼﺡ ﺗﺨﻀﻊ ﻟﻤﺪﻯ ﺗﻮﻓﺮ ﻗﻄﻊ ﺍﻟﻐﻴﺎﺭ ﻭﻟﻦ ﺗﻜﻮﻥ ﺍﻟﺸﺮﻛﺔ ﻣﺴﺆﻭﻟﺔ‬
‫ﻋﻦ ﺍﻟﺘﺄﺧﻴﺮ ﺍﻟﻨﺎﺗﺞ ﻋﻦ ﻋﺪﻡ ﺗﻮﻓﺮ ﻗﻄﻊ ﺍﻟﻐﻴﺎﺭ ﻋﻨﺪ ﺍﻟﻮﻛﻴﻞ ﺍﻟﻤﺤﻠﻲ‬

Client Sing. :‫ﺗﻮﻗﻴﻊ ﺍﻟﻌﻤﻴﻞ‬

* Working Time : Sun - Thu From 08:00 am To 01:00 pm After 02:00 To 04:45 pm