A K C M INSU.

AUXILIARY PRIVATE LIMITED

REG. OFFICE :14 A (D BLOCK BASEMENT), FACTORY ROAD,
(NEAR SAFDARJUNG HOSPITAL), NEW DELHI-110 029
TEL : +91- 62396-45920 EMAIL : AKCM.HO@GMAIL.COM, PI@AKCMGROUP.COM

REPORT ID:247533 COMMERCIAL INSPECTION REPORT INSPECTION DATE:04-10-2019 INSPECTION TIME: 15:37:26
INSPECTION ADDRESS : JAIPUR

COMPANY NAME FUTURE GENERALI INDIA INSURANCE Parts Description Parts Description
COMPANY LIMITED
COWL SAFE DASHBOARD SAFE
BRANCH OFFICE JAIPUR
BONNET SCRATCH GRILL SAFE
INSURANCE COMPANY REF 30-AKC-041019-900025
BUMPER SCRATCH CABIN SAFE
NO
BODY SAFE LEFT SIDE BODY SAFE
REQUESTER NAME NA
RIGHT SIDE BODY RUSTED HEAD LIGHTS SAFE
CUSTOMER NAME DIVINE OIL AND CHEMICALS
INDICATOR LIGHTS SAFE W/S GLASS SAFE
CUSTOMER ADDRESS JAIPUR
BACK GLASS NA REAR VIEW MIRRORS SAFE
VEHICLE NUMBER RJ20GB6319
EXCAVATOR CABIN NA CRANE CABIN GLASS NA
CHASSIS NUMBER E11885 GLASS

ENGINE NUMBER S70289 FRONT EXCAVATOR NA CRANE BUCKET NA

ODO METER 1732 CRANE HOOK NA BOOM NA

AC NA FANS SAFE
RC VERTIFIED YES
HYDRAULIC SYSTEM NA CHASSIS FRAME SAFE
VEHICLE MANUFACTURER TATA
FUEL TANK SAFE LEFT DOOR SAFE
YEAR OF MANUFACTURE 2018
RIGHT DOOR SCRATCH SEATS SAFE
VEHICLE VARIENT ACE MEGA
TYRES AVERAGE STEPNY SAFE
FUEL USED DIESEL
REAR BODY RUSTED WINDOW GLASSES LT SAFE
VEHICLE COLOUR WHITE
WINDOW GLASSES RT SAFE TYPE OF BODY TRUCK
ENGINE STARTED YES
TAIL LAMP (LT) SAFE TAIL LAMP (RT) SAFE
INSPECTION STATUS

RECOMMENDED
REMARKS

OWNER DECLARATION :
I/WE HEREBY CONFIRM THAT THE VEHICLE HAS BEEN INSPECTED IN PRESENCE OF ME/MY/OUR REPRESENTATIVE.
I/WE HEREBY CONFIRM THAT THE IDENTIFICATION DETAILS AND DAMAGES OF VEHICLE AS NOTED/PHOTOGRAPHS TAKEN BY THE INSPECTING OFFICER ARE CORRECT. NOTHING
HAS BEEN HIDDEN/UNDISCLOSED.
I/WE AGREED THAT REPAIR/REPLACEMENT OF DENTED/CRACK PARTS & REPAIR PAINTING OF DENTED/SCRATCHED PANELS AS PER THIS INSPECTION PHOTOGRAPHS SHALL BE
EXCLUDED IN EVENT OF ANY CLAIMLODGED DURING THE POLICY PERIOD.
I HERE CERTIFY THAT I HAVE SHOWN THE SAME VEHICLE WHICH I HAVE TO GET INSURED AND IF LATER AT THE TIME OF CLAIM IT IS FOUND THAT VEHICLE SHOWN AND
ACCIDENTAL ARE DIFFERENT THEN NO CLAIM ISPAYBLE TO ME.
I HERE CERTIFY THAT I WILL NOT CLAIM FOR DAMAGES EXISTING IN MY VEHICLE WHETHER SAME ARE MENTIONED IN REPORT OR NOT IF SAME ARE SEEN IN PHOTOGRAPH TAKEN
BY THE INSPECTOR.

CUSTOMER SIGNATURE

EXECUTED BY :
JAIPUR/VKI VIJAY SINGH

QC DONE BY :
RAJASTHAN(SUNDER LAL)

THIS IS A COMPUTER GENERATED RECEIPT AND DOESNOT REQUIRE ANY SIGNATURE DOWNLOAD: IMAGES VIDEOS