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    Satisfaction Cum Disharge Certificate Policy Number: - Insured Name

    Uploaded by

    MEHFUZ KHAN
    The document appears to be a certificate for discharging an insurance claim after vehicle repairs. It includes fields for the policy and insured details, signatures of the insured and workshop to accept payment, and instructions to return the signed form for audit purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Satisfaction Cum Disharge Certificate Policy Number: - Insured Name

    Uploaded by

    MEHFUZ KHAN
    33 views1 page
    The document appears to be a certificate for discharging an insurance claim after vehicle repairs. It includes fields for the policy and insured details, signatures of the insured and workshop to accept payment, and instructions to return the signed form for audit purposes.

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    The document appears to be a certificate for discharging an insurance claim after vehicle repairs. It includes fields for the policy and insured details, signatures of the insured and workshop to accept payment, and instructions to return the signed form for audit purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views1 page

    Satisfaction Cum Disharge Certificate Policy Number: - Insured Name

    Uploaded by

    MEHFUZ KHAN
    The document appears to be a certificate for discharging an insurance claim after vehicle repairs. It includes fields for the policy and insured details, signatures of the insured and workshop to accept payment, and instructions to return the signed form for audit purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Trusted since 1906

    SATISFACTION CUM DISHARGE CERTIFICATE

    Policy Number : ___________________________________


    Insured Name : ____________________________________

    I / We of ____________________

    hereby certify that the repairs to my / our vehicle bearing registration no. _________________ have

    been carried out to my / our entire satisfaction and I / We agree that the discharge of the account of

    M/s __________________________________ of Rs. _______________ by the National Insurance

    Company Limited shall be in full discharge of all claim under Motor Policy No.

    ________________________________________ in respect of damage to my / our above said

    vehicle, as the result of an accident which occurred on or about the____day of _______2019.

    Date : _________________

    Place: _________________ Signature of Insured

    ========================================================================

    CLAIM DISCHARGE ACCIDENT (MOTOR) DEPT.

    Workshop Name: Claim No:


    Insured: Surveyor:

    Received this_____day of _______ 2019 from NATIONAL INSURANCE CO LTD the sum of
    Rs____________which I / we accept in full and final satisfaction and discharge of all claim under
    Policy No. in respect of the accident occurred
    to Car / Vehicle No. on or about the____day of _____2019.

    Witness:
    Signature

    Revenue
    Stamp
    Signature of workshop Signature of Insured

    Please return this receipt duly stamped and signed as it is required for Audit purposes.

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