A.

FINAL SURVEY REPORT

Name of the Surveyor Address

Licence No and IIISLA Phone/Mobile
Membership No
Date of Expiry   E mail
REPORT NUMBER REPORT DATE
 
MOTOR FINAL SURVEY REPORT
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.
Cover note / Certificate of Insurance No
Policy No.
Period of cover
Date of Loss/Accident
IDV of the vehicle
Insurance Company’s Claim No.

Policy Issuing Office

Insured Details
and Address
Name of the Insured
with mobile no.
Address

Financiers /
Hypothecation if any
Vehicle Registration No/Temp (Comment on irregularity if any)
Particulars Registration No
Make and Model
Year of Manufacturing
Date of Registration
Registration Valid up to
Chassis Number
Engine Number
Class of vehicle ( Use )
Type of body
Registered laden weight/
 GVW
Un-laden weight
Cubic Capacity
No. of persons permitted
as per RC
Permit No & valid up to (Comment about violation of permit, if any, Contract
and area carriage used as stage carriage etc)
Authorization No & valid
up to and area
Area of operation / Route
Fitness Certificate (Comment on irregularity if any)
valid  up to
Road tax valid up to
Odometer reading

Fuel Used –
Diesel/Petrol/CNG-
LPG/Battery/Dual
system
Whether Insured has
Insurable Interest?
(any distortion in painting , breakage of glasses , pre-
Other details accident patch repairing and exterior wear and tear
including tyre treads )
Name of  driver
Date of Birth
Driving License No (Comment about violation of DL if any)
Date of issue & valid up
to
Driver
Licence Issuing Authority
Particulars
(Please also comment on the validity and effectiveness of
Authorized to drive
DL)
Badge No
Special Endorsement on
licence if any
Load Challan/ Nature of goods carried (Give detailed comments in case of hazardous goods)
Trip Sheet Weight of goods carried (Give detailed Comments if exceeds permitted capacity)
Details Origin and Destination
 LR/Invoice No and date
Transporter ‘s Name
Number of passengers (Give detailed Comments if exceeds permitted capacity,
carried including standing passengers)
Passenger
(Give detailed comments as to the capacity in which each
Details
Occupants and details of the passengers was carried in the vehicle e.g. Comment
if unauthorized travelling.)
Date & Time of accident
Place of accident
Survey Allotment Date
Survey conducted on and
(Write date and time )
Accident place
Particulars Spot survey done by
Cause of Accident as
 
stated in the Claim Form
(Write comments about consistency of damage and if
or by Insured/
damages are not corroborating with the cause)
representative
(Vehicle Registration No. with short description of damage &
Details of TP Vehicle
insurance particulars of TP vehicle )
Death/Injury details of ( Nature of injury , name , age and locality where resides in
Fatality/ Injury Insured Vehicle respect of each person )
Details Death/Injury details of
TP Vehicle
Third Party Property
(Write TPPD details)
Damage
Name of the police
station
Police Report
FIR No and date &
Details
sections
GD and 100 No dial
Other Details  RC FC PER TAX DL CHALLA OTH
Whether documents
and Remarks MIT N/ TRIP ERS
verified , if so what are
SHEET
they (Put a tick)
             
Serial Numbers of major
parts and assemblies (Mention all parts and assemblies with numbers separately)
damaged
Verification of these
serial numbers with
 those mentioned in spot
survey and deviation if
any
Whether MVI Inspection
done
Number of photographs
enclosed
Whether towing done

Assessment done in
accordance with add-on
cover, if any
Any deviation from the
spot survey report?
Comment on status of
garage and workshop. (Also mention any change in garage.)
(authorized/local)
Confirm that damaged
noted in pre-acceptance
inspection report have
been disallowed
Any breach of policy
terms and conditions and
endorsement?
Remarks on Re-
inspection, where Re-
inspection is done by the
same Surveyor
DAMAGES
INSPECTED
(Technical Brief Description of the damages
List of parts
description of
damage )
Old Damages
List of Parts Brief Description of the damages
Noticed
Damages to be List of Parts Brief Description of the damages
excluded due to
electrical/
 mechanical
failure
Assessment of
Loss
Documents
Verified if any
Confirmation of
Salvage Value
and Crushing of
Salvage
KYC from
Insured for
assessed loss
more than Rs.1.0
lac.
Recommendatio
n of any loss
control measures
Close Proximity Details of close proximity and any special comments about the same

Any other comments

(Including any violation of policy terms, exclusions and conditions/Admissibility of the claim and
reasons for the same.)
Every possible care was taken to note down all visual damages however if any internal items remain, a
suitable decision may please to be taken on the basis of cause of accident and photographs.

Issued without bias & prejudice.

 
Enclosures
Photographs (Mention number of photographs. Photographs showing date with time – marked
with all damages with names of damaged parts. Also to include any TP vehicle,
injury, property damage. Signed and stamped)
Copy of estimate
Consent Letter
Surveyor Appointment Letter