Investigator Letter Head (Name, address, Contract etc)
Investigation Report
Deceased/
Claim No. Case No. Court Location State Case Title
Injured Name
Claim Claimant
Case Type Loss Type Mobile No. Panel Counsel Mobile No.
Amount Counsel
Injury/ Death/
MACT/WC
TPPD
Insured's Details
Contact
Policy Holder Contact Details Owner Name on His Complete
Complete Address Details &
Name & Occupation Date of Accident Address
Occupation
Policy Details
Accident covered
Date of
Policy no. Policy Type Coverage Type Policy Period under policy
accident
period (Y/N)
Package /
Comm/
Liability / OD
Pvt.Car/TW
standalone
RC Details
Registration no. RTO Registration date Class of vehicle Vehicle Make Vehicle Model
Com./Pvt Car/TW
Seating Over seating
GVW (in KG) Colour Engine No. Chassis no.
Capacity (Y/N)
Permit details
Covering
Detail of Rout / Permit Valid on
Date of issue Date of expiry Type of permit accident place
States covered DOA (Y/N)
(Y/N)
Fitness Certificate details
Valid on accident date
Date of issue Date of expiry RTO
(Y/N)
Investigator Letter Head (Name, address, Contract etc)
TP Vehicle Details
TP Whether TP Vehicle TP
Whether TP
Vehicle TP Vehicle TP Vehicle TP Vehicle Charge sheet holding Vehicle
Driver charge
Involved number Owner Driver
sheeted (Y/N)
against both Insurance on Insurer
(Y/N) vehicles (Y/N) DOA (Y/N) name
For TPPD Case
Damage Bills / Any Difference
Details of damaged Damage detail Documents Monetary value of the
Docs verified Found / other
property in case of TPPD Available (Y/N) property damaged
(Y/N) remarks
Rs.
Case related other details
(For WC Only)
Case filed Filed against
Charge sheet Employee-
under Section TP Insurer / Name of TP TP Vehicle TP Vehicle
against TP/ Employer
166 / 164 or TP Owner as Insurer Policy number Policy Period
IV/ Both relation exists
163(A) / WC well (Y/N)
(Y/N)
IV Driver's Address Details
Is he an
Age / DL Available
Name Father Name Address Contact no. Accused?
Occupation (Y/N)
(Y/N)
Driving License details
In case of learner In case of learner
Whether
DL Class of vehicles Date of Date of license whether license. Total
learner
Number authorised for issue expiry driver was alone number of
license
(Y/N) passengers in IV
In case of NO DL whether
Driving license valid Fake DL /Invalid DL / Whether DL extract taken from RTO /
chargesheet contains 3/181
(Y/N) No DL Online (Y/N)
(Y/N)
Online / RTO verification
Investigator Letter Head (Name, address, Contract etc)
Profession/ Occupation of deceased/ Injured
Name of Income
Age of
Profession/ company Income proof proof
deceased / Address
Occupation details /organization Available verified
Injured
working for (Y/N)
Income of deceased/ Injured
Whether
working at the Income Proof Remarks if
Income Type Goss Income Net Income
time of Genuine (Y/N) any
accident (Y/N)
ITR/Salary slip
Petitioners / Dependents Detail
Relation with
S. Marital Employed/
Name of Petitioner / Dependent Age Gender deceased / Dependency
no. Status Unemployed
Claimant
1 Wife Yes/No Married
2 Son Unmarred
3
4
5
6
161 Eyewitnesses details
Name of Visit done
Father Name Complete address Contact No. Remarks
Eyewitness (Y/N)
Investigator Letter Head (Name, address, Contract etc)
Details of FIR/GD
FIR Under Sections FIR
Whether FIR is Date of FIR Delay (No. of
Time of FIR Lodged
filed (Y/N) FIR days) IPC / BNS M.V.Act Others by
Name
Regn no Colour of Regn No of
Relation of the FIR against Name of of
of accused Accused Vehicle accused
complainant IV driver/TP accused accused
accused vehicle as (IV/TP/Both/Others) vehicle as
with petitioner driver/Both driver driver in
vehicle given in FIR per petition
petition
Rank of
Name of police station/chowki District State Name of IO
IO
Spot Panchnama Details
Vehicle seized Spot Sketch available
Spot sketch date Special point noted if any
on spot (Y/N) (Y/N)
Vehicle Seizure Memo Details
No. of the vehicles seized Details of DL seized (IV)
Other Documents seizures (IV)
from the spot
DL Number Driver Name
RC / Permit / FC / other
Arrest Memo Details (IV)
Date of Under Arrested by (Name of Rank of
Name of person arrested Time of arrest
arrest section police officer) IO
Details of MVI report (IV)
Damages Damages on Damages on
Date of inspection Damages on right No Damage
on left front rear
Details of Dead body Panchayatnama / Morgue Register / Inquest
Gap B/w Accident &
Panchnama date Deceased Name Reason of Death as per Panchas
Panchnama
Investigator Letter Head (Name, address, Contract etc)
Chargesheet Details
Charge
Sections in charge sheet
Chargesheet filed Chargesheet Name of sheeted
Rank of IO
(Y/N) date IO vehicle
IPC / BNS MV Act Others
number
Chargesheet Whether closed as
Accused Accused TP/IV/Both Charge abated (Accused
against mistake of facts/
driver/s name driver death) (Y/N)
IV/TP/Both/others Nontraceable (Y/N)
MLC Details
Distance
Injured/ Whether
MLC Date/ Doctor's Hospital from City /
Deceased MLC Details Intoxicated
Time name Name accident State
name (Y/N)
spot
Treatment details/ BHT details/ Discharge summary
Differenc
Bills verified
Admission date Discharge date Total Bills e in Injury details
(Y/N)
Amount
Distance from accident Fracture / City /
Doctor Name Hospital Name
spot Amputation State
Wound certificate details
Date of Injury
RTA/ Assault/ Doctor's Hospital WC verified
certificate / Difference if District State
Self Fall name Name (Y/N)
Number any
Disability Certificate details
Hospital /
Date of Doctor's DC verified
Disability % Injury details CMO District State
certificate Name (Y/N)
Name
Date of death Postmortem Details
of deceased Date of PM Cause of death Others
Viscera report details
Date of report Cause of death Others
Investigator Letter Head (Name, address, Contract etc)
Fraud Suspected / Loss minimization
Fake DL, No DL, Invalid DL
Hire N
Reward No DL (3/181 Chargesheet Vehicle Driver Fraud case
Fake DL Invalid DL
applied) against TP Implant Implant (other type)
Remarried Occupant’s Not covered Gratuitous / Fitness
Permit
Spouse case (Act under policy Unauthorized certificate No RC Other if any
violations
(Death) only) T/C (other) Passenger violations
Accident Brief
As per Petition
As per Criminal
Papers
As per the Field
Investigation
Investigator Letter Head (Name, address, Contract etc)
Field Investigation Performed
Claimant Visit Detail
and Present Condition
Insured Visit Detail
Driver Visit Detail
Eyewitness and Spot
Visit Detail
Investigator Letter Head (Name, address, Contract etc)
Investigation Findings
FIR delay Reason:
Findings from Field Visits:
Relationship between Insured, Driver and Claimant:
Newspaper / Social Medial findings:
Video recordings / Written statements:
Findings from Vehicular Papers: (DL, Permit, Fitness, RC etc)
Loss Minimization and Red Flags:
Gap in Sequential flow of events:
Observation from Treatment papers:
RTI field and reason:
Final Observations
