THE UNITED INSURANCE S.C.

MOTOR CLAIM CHECK LIST

DOCUMENTS ATTACHED
S/N DESCRIPTION YES NO N/A PAGE # REMARK
1 Duly Completed Claim Notification Form
2 U/W & Account verification
3 Photocopy of Driving License
4 Photocopy of Title Certificate
5 Traffic Police Report
6 Photographs
7 Post Risk Survey Report
8 Settlement of Excess
9 Settlement of Outstanding Premium
10 Collection of Proforma from four Garages
11 Work order (Body)
12 Work order (Mechanical)
13 Survey Report for Mechanical Damage (if any)
14 Dealer’s Proforma Invoice
15 Parts Price Comparison Table
16 Any Additional Survey Report
17 Breakdown of Contribution imposed
18 Satisfaction Note
19 Collection of Salvage Items
20 Discharge Note (for total loss)
21 Power of Attorney (for total loss)
22 Title-deed book (for total loss)
23 Other Relevant documents (List below)
24 Provision Adjustment Previous 1stRevison 2ndRevison 3rdRevison
Amount
Date
ADDITIONAL DOCUMENS REQUIRED For TP CASES
A For BODILY INJURY / DEATH
1 Police Report Indicates Name of Injured
2 Medical Bills Attached
3 Medical Board Certificate (if appropriate)
4 Post Mortem Certificate (if death occurred)
5 Legal Heirs Certificate
-
-
B For PROPERTY DAMAGE
1 Police Report Indicates Name of TP Owner
2 Survey Report
3 Proforma Collected form four Garages
4 Ownership Certificate of Third Party
5 Discharge Receipt
-
-
Number of Pages in the Claim File
  Not Applicable

THE UNITED INSURANCE COMPANY S.C

CHECK LIST FOR MOTOR CLAIM

Detail of Claim

Name of Insured :
Claim No. :
Policy No. :
Period of Insurance :
Plate/Type of Insured Vehicle:
Sum Insured :
Excess (if any) :
Date of Accident :
Type of Accident :
Date of Report :

Documents to be Enclosed (put -/ mark)

1. Claim Form:
2. U/W and Accounts Verification form:
3. Inspector Report: ______
4. Police Report : ________
5. Garage’s Repair Estimates : _______
6. Survey Report : _______
7. Other Documents (specify): _______

If any of the above document/s is/are not available give reason:

C. Garages Estimates Amount Invited By D. Total Loss

Documents
1. ___________________ Br. ___________ _____________ Police Report : ______
2. ___________________ Br. ___________ _____________ Power of Attorney: ___
3. ___________________ Br. ___________ _____________ Inland Revenue : _____
4. ___________________ Br. ___________ _____________ Title Book : _________
Survey Estimate Br. ___________ _____________

Approval required for (body work, mechanical work, third party property/bodily injury or death,
guarding etc): ______________________________________________________
_________________________________________________________________________________
_______________________________________________________________
CHECKED BY : APPROVED BY

DATE :