Surveyor's Report

For
Motor Insurance

Insurer : Siddhartha Insurance Limited

Address : Babarmahal, Kathmandu
Insured :
A/c :
Vehicle No. : Ba 3 Kha 8276
Third Party : N/A

Submitted To
Siddhartha Insurance Limited
Babarmahal, Kathmandu

Submitted By
Er. Bishworam Parajuli
Surveyor
Lalitpur Metropilitan City Ward No.-28, Lalitpur, Nepal
Contact : 985117019 (Cell)

Report No. : 01/SID/076-77

Submitted Date: 2076/04/16

Er. Bishworam Parajuli Insurance SurveyorSurvey License no. 852/074/075Lalitpur-28, Lalitpue, Ph
no. 9851017019

Ref. No. :01/SID/076-77

This Report is issued without prejudice, in respect of cause nature and extent of loss/damage
and subject to the terms and conditions of the Insurance Policy.

Policy No. : NGT/181119MCY/01764

Period of Cover : 2076.03.11 TO 2077.03.10
1.0
Date of Loss : 2076.04.05 (2019.07.21), 16:00
Insurance Company's Claim No. : N/A
Date and Time of : 2019.07.21, 16:00
Accident
Place of Accident
(Write if Place of
: Chitwan
Accident is
Different)
Survey Allotment : 2019.07.29
Date
Survey Conducted
Accident on and Place
2.0
Particulars : Syakar Trading Company Pvt.Ltd, Teku,Kathmandu

According to the version of insured representative,

Insured vehicle was parked near the river for
washing purpose. All of Sudden, water level at the
Cause of Accident
river incresed rapidly, Insured vehicle got down
as Stated by Isured :
cause of high flow rate of water.Thus, water got
Representative
enter inside the engine of the vehicle.

Policy Issuing : M/s.Siddhartha Insurance Ltd. Babarmahal,Kat

Office and Address
Name of the
Insured and : Mr. Moti Lal Shrestha,Gajuri,Dhading
Address
Insured
3.0
Details Name of the
Insured Present at : Mr.Moti Lal Shrestha
the Spot
Financiers/
Hypothecation if :
any
 Registration
Er. Bishworam Parajuli Insurance : 003 pa 8863
No.SurveyorSurvey License no. 852/074/075Lalitpur-28, Lalitpue, Ph
no. 9851017019 Make and Model : XR 190L
Year of : 2018
Manufacturing
Date of : 2075.10.14
Registration
Chassis Number : LALMD4394J3007141
Own Engine Number : MD43E-2012827
4.0 Vehicle Class of the
Details : Private
Vechile
Type of the Body : Factory Made
Registered Laden : N/A
Weight
Cubic Capacity/
: 190 cc
Horse Power
No. of Persons : 2 Seat
Permitted
Name of the Driver : Mr.Moti Lal Shrestha

Driving Licence
: 06-312481
No.
Validity of
Driver Liscence : 2077-09-05
5.0
Particulars
Licence Type and
: A,K
Category
Special
Endorsement on :
Licence If any
Reported to police : N/A
Police
Name of Police
6.0 Report : N/A
station
Details
Report Date : N/A
Registration No. : N/A
Details of Make and Model : N/A
7.0
TP Vehicle Year of
: N/A
Manufacturing
Death/Injury
details of Insured : N/A
Vehicle
Fetality/
8.0 Injury Death/Injury
Details details of TP : N/A
Vehicle
Third Party
: N/A
Property Damage

9.0 EXTENT OF DAMAGES :

On careful examination of the damaged vehicle, the damages found are noted below :
Insured
Er. VehicleParajuli Insurance SurveyorSurvey License no. 852/074/075Lalitpur-28, Lalitpue, Ph
Bishworam
no.1 9851017019
H/L Assy Lh, Cover Fr Bpr Lwr, Cover Bumper Lwr : Damaged/Broken
2 Other many parts : Dent/ Repair
10.0 LOSS ASSESSMENT:
Submitted repairing estimates were studied & found lowest quotation as follows:

1 All busy auto-workshop,Mahalaxmi municipality, corridor, lalitpur Rs. 160,900.00

Total Qt. Amount Rs. 160,900.00
Submitted repairing estimate was studied thoroughly & assessed the loss as per extent of
damages only after confirming labor charges & parts replacement cost at local market.
11.0 LOSS ASSESSMENT IN DETAIL:
11.1 Loss Assessment of the Insured Vehicle
A. Parts Replacement:
a) Metallic & other items:
S. No. Particulars Qty.Unit Rate Claimed Amt. Assessed Amt. Remarks
1 Lamp Assy Head Lh 1 Pc 25,000.00 25,000.00 55,000.00
2 Lh gala 1 Pc 4,400.00 4,400.00 200.00
3 Radiator Grill 1 Pc 47,000.00 47,000.00 4,500.00
Sub-Total 82,302.00 59,700.00
Depreciation for Below 2-3 yr Vehicle 15% 15%
Total
Less Salvage Amount Lumsump
Amount after salvage -
VAT 13% -
Sub Total (a) -
b) Rubber & Plastic items:
S. No. Particulars Qty.Unit. Rate Claimed Amt. Assessed Amt.
1 Wiper Jar 1 Pc 8,500.00 8,500.00
2 Bulb 1 Pc 1,200.00 1,200.00
3 Head Light Jack 1 Pc 400.00 400.00
Sub-Total
Less 50% -
-
VAT 13% -
Sub total (b) -

c) Glass Items:
S. No. Particulars Qty. Rate Claimed Amt. Assessed Amt. Remarks

Sub total ( c ) - -
VAT 13% -
Total -
Total of A (a+b+c) 82,302.00 -

B. Labor Charges:
S. No. Particulars Qty.Unit. Rate Claimed Amt. Assessed Amt. Remarks
1 Fr chassis Repair 1 Pc 5,000.00 5,000.00 5,000.00
2 Lh beam Repair 1 Pc 4,800.00 4,800.00 4,000.00
3 Born Hood Dent 1 Pc 15,500.00 15,500.00 950.00 o/f Charge
4 Dash board panel sub-assy,Repair 1 Pc 14,000.00 14,000.00
5 Bishworam
Er. Fr Door Ass/Disass 1 Pc
Parajuli Insurance SurveyorSurvey 900.00no. 852/074/075Lalitpur-28,
License 900.00 Lalitpue, Ph
6 9851017019
no. Dash board 1 Pc 15,000.00 15,000.00
7 Born Hood 1 Pc 1,800.00 1,800.00
8 Radiator grill 1 Pc 1,900.00 1,900.00
9 Head Light 1 Pc 1,000.00 1,000.00
10 Bumper 1 Pc 1,000.00 1,000.00
11 Painting 1 Pc 9,000.00 9,000.00
12 Wiring Charge 1 Pc 4,500.00 4,500.00
Total 74,400.00 9,950.00
VAT 13% 1,293.50
Total of 'B' 11,243.50
Total of A + B(Insured Vehicle) 11,243.50

14.0 ADEQUACY OF & AVERAGE CLAUSE: .

Thus, the entire total loss due to accident is assessed Rs. 11243.5 out of Quoted Amount
NRs. : 160900

15.0 SUPPORTING DOCUMENTS:

Related documents provided by insured are attached herewith. Insured is also advised to submit
all original documents for verification to the insurance company as required.

16.0 PHOTOGRAPHS
All the Photographs are attached herewith
17 CONCLUSION & RECOMMENDATION:
17.1 Keeping in view with the nature of accident and as per version of the claimant, the loss is
confirmed due to accident, which is observed.

17.2 The above statement is complete to the best of our knowledge and belief.
17.3 The above loss-assessed amount is strictly subject to the Insurance Policy's Terms & Conditions
and insurance company's approval only.
17.4 Every possible care was to note down all visual damage however if any internal items remain

…………………………………
Er. Bishworam Parajuli
Insurance Surveyor
Survey License No. 852/074/75
 Er. Bishworam Parajuli Insurance SurveyorSurvey License no. 852/074/075Lalitpur-28, Lalitpue, Ph
no. 9851017019

Remarks

Lumsump

Remarks

Remarks

o/f Charge
Motor Survey Photographs 7
Motor Survey Photographs 8
 Motor Survey Photographs 9

Photo Taken After Repair:

Motor Survey Photographs 10
 PAN No. : 106903139 PAN No. : 106903139
शश गणणशशय नमम शश गणणशशय नमम
Er. Puran Subedi Chhetri Er. Puran Subedi Chhetri
Bharatpur-11, Chitwan Bharatpur-11, Chitwan

Date:- Date:-
Bill No.: 138 Bill No.: 138

Customer Name: Siddhartha Insurance Limited Customer Name: Siddhartha Insurance Limited
Insured : - Insured : -
A/C - A/C -
Vehicle Regd. No. Ba 3 Kha 8276 Vehicle Regd. No. Ba 3 Kha 8276

S.N. Particulars Quotation Amt.Rate Amount S.N. Particulars Quotation Amt. Rate Amount
1 Professional Fee 160,900.00 5,000.00 5,000.00 1 Professional Fee 160,900.00 5,000.00 5,000.00

Local Local
2 2.00 1,000.00 2,000.00 2 2.00 1,000.00 2,000.00
Transportation Fee Transportation Fee

3 Photographs 6 Nos @ 25 150 3 Photographs 6 Nos @ 25 150.00

Total 7,150.00 Total 7,150.00
Discount 0 Discount -
Net Amt. 7,150.00 Net Amt. 7,150.00
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