THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

Motor Claim Satisfaction Voucher

Claim No:________________________________________

I/ We hereby acknowledge having received from _________________________________garage

my/our vehicle____________________bearing Registration Number_______________which has

been repaired to my/our satisfaction, and I/We admit that the payment of ₹ ________________

on account of such repair by The New India Assurance Company Limited to the above garage is in

full and final discharge of my/our claim upon the said company under Policy No. ______________

in respect of the damage caused to the above mentioned vehicle in an accident which occured

on___________________

Place:_______________

Date:________________

Signature of the Insured_____________________________

Name of Insured:__________________________________

Regd & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001
TOLL FREE No: 1800 209 1415 https://www.newindia.co.in