SAMPAT LAL LUNIYA

INSURANCE SURVEYOR & LOSS ASSESSOR BHERU-CHOWK

Lic. No. SLA/17261 : Valid upto 11/11/2026 SUMERPUR ; DISTRICT-PALI (RAJ.)
III SLA Membership No. F/W/03263 Mob No- 9414123588
PAN No- AAGPL 1811N Email ID: sllunia@hotmail.com

Ref No: 680 Date: 29.04.2025

PRIVATE & CONFIDENTIAL MOTOR (FINAL)SURVEY REPORT

This report is issued by me as licenced Surveyor without prejudice, in respect of cause, nature
and extent of Loss/damage and subject to terms and conditions of the Insurance policy.
MI Claim No.- 98000031250391018771
1. Insurer : The New India Assurance Company Ltd.
MIBL
2.a Insured (as per policy) : Sh Oka Ram S/O Sh Bhala Ram
2.b Insured ( as per RC) : Sh Oka Ram S/O Sh Bhala Ram
3. Policy/Cover Note No : 98000031240915144984 with ND cover
4. Period of Insurance : 03.08.2024 To 02.08.2025
5. IDV : Rs. 1024100/-
6. H.P.A. : HSBC Bank Ltd.
Vehicle Particulars
(a) Registration No. : RJ16/UA-7166
(b) Date of Registration : 10-Aug-24
(c) Date of Purchase : 3-Aug-24
(d) Chassis No. : MA3BNC62SRG842660 Physically Verified
(e) Engine No. : K15CN9563849 Physically Verified
(f) Make/Model. : Maruti Ertiga VXI (O) CNG / 2024
(g) Type of body. : Rigid
(h) Class of vehicle. : Motor Car / LMV
(i) Pre accident condition : Road-worthy
(j) CC : 1462
(k) Unladen weight. : 1250 Kgs
(l) Fitness cert.No. : N.A. Valid up to -
(m) Permit No. : N.A. Valid up to -
(n) Type of permit : N.A.
(o) Route of operation : N.A.
(p) Tax Particulars : OTT Paid
(q) Passenger Carrying Capacity : 7 in all
(r) Type of Fuel : Petrol/CNG
Driver's Particulars
(a) Name of driver. : Sh Oka Ram Kumhar S/O Sh Bhala Ji
(b) M.D.L.No. : RJ16 20090047033
(c) Date of issue. : 03.11.2009
(d) Valid upto. : 02.11.2029 (NT)
(e) Issuing authority. : DTO- Jalore
(f) Type of licence. : MCWG & LMV Only
(g) Badge No. : -
(h) Endorsement No. : -
Accident Particulars
(a) Date & Time of accident. : 13-Apr-25 at about 11 AM
(b) Place of Accident : Near Bus Depot, Jalore
(c) Date of Allotment of survey : 17.04.2025
(d) Date of survey. : 17.04.2025 & onwards
(e) Place of survey : M/S LMJ Services Ltd, Sumerpur
(f) Milometer Reading : 48460 KM

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 SAMPAT LAL LUNIYA

Ref No: 680 Reg. No. RJ16/UA-7166

SUMMARY OF ASSESSMENT

ESTIMATED ASSESSED
DESCRIPTION
AMOUNT AMOUNT
Total Labour Charges 32450.00 18599.16
Total Cost of Parts 40467.00 17324.98
Less : Excess Clause 1000.00
Total 72917.00 34924.14
Less:Depreciation on Rubber parts@ 0% 0.00
Less: Depreciation on Metal parts@ 0% 0.00
Net Assessed Amount 34924.14

FOR INSURERS INFORMATION ONLY:-

Approximate value of spare parts 17324.98
Depreciated Value 17324.98
Expected Salvage Value 0.00

DETAIL OF PEOPLE CARRIED : Parked Vehicle/N.A.

F.I.R. Details : Not Lodged.(As per claim form)
Third Party Loss/Injury : Reported None (As per claim form)

CAUSE & NATURE OF ACCIDENT: (As per claim form & discussion held with insured )

IV was parked near Jalore Bus Depot, Jalore. Meanwhile, a unknown vehicle hit to parked IV,
during its reverse operation at front LH side. Thus, IV got damaged.

INSTRUCTION RECEIVED FROM:- From Maruti Surveyor Portal, The New India Assurance Co.
Ltd.

ASSESSMENT OF LOSS:-
The accidental Vehicle was inspected by me & noted the damages. The estimate of M/S LMJ
Services Ltd., Sumerpur was discussed with Insured, in the presence of repairer Sh Mansoor and
assessment has finalized as per attached assessment sheet.

DOCUMENTS :-Registration & Driving License were checked & found as per detail given.

Thanking & assuring you of my best attentions at all the times.

Yours Faithfully,

[SAMPAT LAL LUNIYA]

Surveyor and Loss assessor
Encl.-Digital Photo No -16 (F) + 4 (R )=20

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 SAMPAT LAL LUNIYA
ASSESSMENT CUM BILL SCRUTNING REPORT
Ref No: 680 Reg No. RJ16/UA-7166
(A) COST OF PARTS-
ESTIMATE ASSESSED BILL NOW ADJUSTED
S.No. DESCRIPTION GST
AMOUNT AMOUNT PRODUCED METAL PLASTIC GLASS
1 UNIT HEADLAMP LH PRESSED & BROKEN 18% 6600.00 5847.45 5847.45 0.00 5847.45 0.00
2 FAN ASSY, COOLING - 6450.00 0.00 0.00 0.00 0.00 0.00
3 PANEL, FRONT HOOD PRESSED & BENT AT LH SIDE 28% 5835.00 4558.59 4558.59 4558.59 0.00 0.00
4 GRILLE,RADIATOR UPPER - 5590.00 0.00 0.00 0.00 0.00 0.00
5 RADIATOR ASSY - 5240.00 0.00 0.00 0.00 0.00 0.00
6 CONDENSER ASSY - 3960.00 0.00 0.00 0.00 0.00 0.00
7 BUMPER,FRONT PRESSED & CUT/BROKEN AT LH SIDE 28% 2750.00 2148.43 2148.43 0.00 2148.43 0.00
8 PANEL,FRONT FENDER,L PRESSED & BENT 28% 1840.00 1437.50 1437.50 1437.50 0.00 0.00
9 LINING COMPFRONT FENDER - 725.00 0.00 0.00 0.00 0.00 0.00
10 GRILLE,RADIATOR LOWER - 265.00 0.00 0.00 0.00 0.00 0.00
11 HINGE COMP,FRONT HOOD,R - 260.00 0.00 0.00 0.00 0.00 0.00
12 HINGE COMP,FRONT HOOD,L - 260.00 0.00 0.00 0.00 0.00 0.00
13 BEZEL,FRONT FOG LAMP,L - 110.00 0.00 0.00 0.00 0.00 0.00
14 BEZEL,FRONT FOG LAMP,R - 110.00 0.00 0.00 0.00 0.00 0.00
15 HOLDER,FR BUMPER FRONT,L - 100.00 0.00 0.00 0.00 0.00 0.00
16 HOLDER,FR BUMPER FRONT,R - 100.00 0.00 0.00 0.00 0.00 0.00
17 COVER,FRONT FOG LAMP BEZEL,L - 71.00 0.00 0.00 0.00 0.00 0.00
18 COVER,FRONT FOG LAMP BEZEL,R - 71.00 0.00 0.00 0.00 0.00 0.00
19 HOLDER,FR BUMPER SIDE,L - 65.00 0.00 0.00 0.00 0.00 0.00
20 HOLDER,FR BUMPER SIDE,R - 65.00 0.00 0.00 0.00 0.00 0.00
TOTAL 40467.00 3585.93 5996.09 7995.88 0.00
ADD: GST 18% GST PAID 1052.54 0.00 1052.54 0.00
ADD: GST 28% GST PAID 2280.47 1678.91 601.56 0.00
TOTAL 40467.00 6918.94 7675.00 9649.98 0.00
Less: Depreciation 0% On Non Metals 0% On Metals 0.00 0.00 0.00
Total 7675.00 9649.98 0.00
TOTAL ASSESSED COST OF PARTS 17324.98
(B) COST OF REPAIRS-
S.No. DESCRIPTION ESTIMATE AMOUNT BILL PRODUCED ASSESSED AMOUNT
1 R&R charges of headlamp LH-100+ panel front hood-350+ 18% 5000.00 1200.00 1200.00
front fender LH-300+ bumper front-450 = 1200
2 Denting charges 18% 4000.00 0.00 0.00
3 Painting charges(Pearl Paint) of panel front hood-3685+ 18% 18500.00 14562.00 14562.00
fender LH-5324+ bumper front-5553 = 14562
Less Dep. on allowed total Painting Charges of Rs. 0 /- @ 12.50% = 0.00
TOTAL 27500.00 15762.00 15762.00
Add: GST 18.00% 4950.00 2837.16 2837.16
TOTAL ASSESSED COST OF REPAIRS 32450.00 18599.16 18599.16

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 SAMPAT LAL LUNIYA
ASSESSMENT CUM BILL SCRUTNING REPORT
Ref No: 680 Reg No. RJ16/UA-7166

ABSTRACT OF ASSESSMENT
[A] Assessed cost of Parts : Rs. 17324.98
[B] Assessed cost of Repairs : Rs. 18599.16
[C] Less: Excess Clause : Rs. 1000.00
[D] Less: Salvage Value : Rs. 0.00
NET LOSS ASSESSED : Rs. 34924.14 or say 34924.00
(Rupees Thirty Four Thousand, Nine Hundred & Twenty Four Only)
REMARKS:-
{1} The Damages considered are in accordance with Cause & Nature of Accident Only.
{2} The Cost of Parts & Labor is allowed as per authorized dealer's retail price list.
{3} Last claim survey photos dated 18/11/2024 has been checked by us & loss assessed accordingly.
{3} Re-inspection of IV carried out on 28.04.2025 & it found repaired as per our assessment.
Depreciated Cost Amount GST Total Value
Parts Allowed @ 28% GST 8144.52 2280.47 10424.99
Parts Allowed @ 18% GST 5847.45 1052.54 6899.99
Labour Allowed @ 18% GST 15762.00 2837.16 18599.16
Total 29753.97 6170.17 35924.14

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