Subrata Pahari

[ Surveyor and Loss Assessor] Residence Cum office

License no- SLA-68511/Exp on 6.4.2019 93,Raimohon Banerjee Road
B.Sc in Mech Engg,M.B.A. in O.R st
Suryabartha Apatt,[1 Floor]
B.O.E[W.B] All types of boiler Operation Engineer Kolkata-700108 Ph No-9830343881
ANST-L-II holder in welding, Automobile Engineer, Consulting Engineer & Valuer
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Motor,Engg [ Chartered Valuer, Valuer Kolkata High court]
SURVEYOR STAKE CODE
Survey Report No. sp/fs/13/2019 Date of Report: 02/Aug/2019

MOTOR SURVEY REPORT

Date of allotment 30/Jul/2019 Place of survey Claim No.

30/Jul/2019 M/S SHREE AUTOMOTIVE P LTD
Dates of survey and ASHOL LEYLAND WORKSHOP, NH-6 10854
subsequent visits JUNGLE PUR, NH-6 HOWRAH
EST VALUE RS. 18816, DATED-30.07.2019 Received on
Spot Surveyor NOT DONE
Date of Re-Inspn. NIL Assessed loss Rs.15,360

Policy issuing Office THE NEW INDIA ASSURANCE COMPANY LIMITED

Office code 100900 NATIONAL INSURANCE CO LIMITED
1 Name of the Insured (as per policy) M/s. CALCUTTA STATE TRANSPORT CORPORATION
2 Phone and Mobile Nos. of insured
3 Address for communication 45, G.C AVENUE, KOLKATA-700013

4 Contact person & Mobile No. Mr. TAPAS GHOSH

5 Present Registered owner M/S CSTC With effect from 03/Dec/2014

POLICY PARTICULARS
6 Policy number 100900311810005140 Period of Insc: 07/Dec/2018 06/Dec/2019
7 Endorsements (IMTs imposed)
8 I.D.V. of the vehicle & accessories For Vehicle: 28,12,500 For accessories: Rs.0.00
9 HP/Hypothecation details on policy Hypothecated to NIL
10 Endorsement No. on policy NIL w.e.f.
11 Endorsement type (Transfer/LPG/Electrical fittings/Others) NIL

VEHICLE DETAILS
12 a) Registration b) Year of Mfg.
Number WB-11-1581 c) Date of Regn.
2014
03/Dec/2014
d) Make ASHOL LEY LAND e) Class of vehicle HPV
13 Chassis No. MB1PLEHC2EATE4940 14) Engine No. ETEZ418769
15 Colour of vehicle BLUE 16) OMR 214537 Km During Survry
17 Type of body BUS 18) Seating capacity 34[ I/D] 19) Cubic capacity: 5759 CC
20 ULW (Kg) 10400 KG RLW (Kg.) Payload (Kg) 5800 KG
21 HPA with (as per RC) NIL HP w.e.f. NIL

Submitted to NIAC Page 1 of

3
 From To From To
22 Tax paid EXAMPTED AS GOVT BUS CSTC
23) Fitness validity 03/Dec/2014 15/Feb/2021
24 Registration validity 03/Dec/2014 15/Feb/2021 25) Permit validity EXAMPTED
26 Permit No. EXAMPTED AS GOVT BUS CSTC 26a) Permit Holder CSTC
27 Type of permit Public Service Vehicle Area of operation ALL W.BENGAL
28 Trip sheet No. & Date NOT AVAILABLE Goods carried N.A
29 Gross weight of goods carried (in Kg) N.A 29a) No. of persons carried (incl driver) NIL
30 Nature of Fuel (Petrol, LPG, CNG, Diesel, Dual-fuel, Hybrid, etc.) Diesel
31 Alteration in the vehicle if any, reg fuel, extra fittings in contravention of RC N.A
32 Whether the alteration noted above is duly endorsed by RTO No
33 If there is any alteration, furnish the details thereof NO
34 State, whether such alteration is material to this accident No

DRIVER DETAILS
35 Name of Driver Mr. TAPAS GHOSH Date of Issue 30/Jun/1998
36 Capacity in which the vehicle was driven Date of renewal 21/Jun/2022
37 DL Number WB-0119980027949 38) Issued by PVD KOLKATA
39 Type of vehicle From To Type of vehicle From To
MCWOG MCWG
LMV-NT LMV-TV 30/Jun/1998 21/Jun/2022
HMV/HTV Others - Specify
Others - Specify Others - Specify
40 Badge number Badge w.e.f. Date
41 DL valid for class of vehicle under claim? Yes 42) DL valid as on the date of accident? Yes

ACCIDENT PARTICULARS
43 Date of accident (as per claim form) 28/Jul/2019 44) Time of accident (as per claim form) 7. 45 A.M
45 Place of accident (as per claim form) DEPOT PREMISES, SALT LAKE

46 Was any third party vehicle involved? No 47) Was any TP property involved? No
48 TP Vehicle/property damage details NIL
49 Details of TP injury / death NIL

50 CAUSE OF ACCIDENT
AS PER CLAIM FORM ENTRY AND FURTHER DISCUSSION HAD WITH INSURED IT WAS LEARNT THAT WHEN THE
VEHCILE WAS PLACING OUT SIDE THE SHED, SUDDENLY ONE ANOTHER VEHICLE DASH ED FROM FRIGHT SIDE AND
SUSTAINED DAMAGE AT RIGHT SIDE .
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BSERVATION /OPINION :- THE UNDERSIGNED INSPECTE THE VEHCILE AT THE WORKSHOP OF SHREE
AUTOMOTIVES AND STOOD CONSISTENT.
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AMAGE:- ONLY WINDOW GLASS GOT DAMAGE.

POLICE RECORDS
51 FIR / CSR / GD Entry Number NIL Date of FIR/CSR/GDE NIL
52 Name of Police station NIL
53 Reasons for not making FIR / GD entry NIL

54 Compromise letter obtained if any NIL

Submitted to NIAC Page 2 of 3

 DETAILS OF REPAIRER
55 a) Name & address of Repairer M/S SHREE AUTOMOTIVES P LTD, JUNGLE PUR, NH-6, HOWRAH

(b) Contact Person and Contact No(s). Mr. SUJIT DAAS

(c) Is the Repairer authorised service centre for the subject vehicle? Yes
(d) Estimated amount & Supplementaries Rs.18,816.00 Rs.18,816.00

SUMMARY OF ASSESSMENT
Item of assessment Amount - Rs.
Labour charges (including Taxes if any) 1,770.00
Parts recommended at cost 14,591.00
Part recommended at Normal depreciation @ 35% 0.00
Parts recommended at 30% Depreciation 0.00
Parts recommended at 50% Depreciation 0.00
Towing charges (incl. Spot repair charges) 0.00
Additions and Deletions from Assessment Sheet 0.00 0.00 0.00
Gross assessed loss 16,361.00
Less: Compulsory excess 1,000.00
Less: Imposed Excess 0.00
Less: Voluntary Excess 0.00
Less: Salvage value 0.00
NET ASSESSED LOSS 15,361.00

NET PAYABLE LOSS (ROUNDED OFF TO) 15,360

Payment to be made to Insured or Repairer or Financier or Others Insured
If payment is to be made to Repairer, whether Satisfaction Voucher from the insured is obtained? Not applicable

56 CERTIFICATION
(a) The Engine and Chassis numbers were physically verified and found tallied with the Policy and R.C.
(b) The cause of accident is relevant to the observed damage.
(c) AGREEMENT ;- Loss was discussed with the repairer and stood consistent.
(d) The recommended repairs and replacements are relevant.
(e) Wherever Repairers are not authorised dealers, rates of spares were verified with the rates of authorised dealers.
(f) Damage which are not relevant to the cause of accident are also mentioned and not considered for assessment.
(g) Insured's Declared Value as per the policy is ADEQUATE when compared with the market value.
(h)
(i)
57 Verification with Verified Copy enclosed Verification with Verified Copy enclosed
originals (Yes / No) ( Yes / No ) originals (Yes / No) ( Yes / No )
R C Book Yes Yes Trip Sheet
Tax card Yes Yes Others (Specify)
Driving Licence Yes Yes Others (Specify)
Permit Others (Specify)
Any other observations

THIS REPORT IS ISSUED WITHOUT PREJUDICE IN RESPECT OF CAUSE, NATURE AND EXTENT OF
LOSS/DAMAGE AND IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY OF INSURANCE

Seal SUBRATA PAHARI

SURVEYOR AND LOSS ASSESSOR

Submitted to NIAC Page 3 of 3