Er.Bishworam Parajuli Lalitpur-28, Lalitpur License no.

852/074/075

Surveyor's Report
For
Motor Insurance

Insurer : Siddhartha Insurance Co. Ltd

Address : Babarmahal, Kathmandu-11, Kathmandu
Insured : Nityam Traders
A/c : Avdesh Kumar Sah
Policy No. : HTD/18/19/MCY/00067
Claim No. : C10474/075/076
Date of Loss : 3/11/2076
Vehicle No. : NA 65 PA 2198
Third Party : BA 70 PA 9985

Submitted BY:
Er. Bishworam Parajuli
Nepal Engineering Council (NEC) Registration No. : 207 "A" Industrial
Insurance Surveyor Liscence No. : 852/074/075
Lalitpur-28, Lalitpur Nepal

Date: 2076/05/10

Page 1 of 10
Er.Bishworam Parajuli Lalitpur-28, LalitpurDate: 2076/05/10 License no. 852/074/075
Ref No. : 02/076/077

To,
Siddhartha Insurance Co. Ltd
Babarmahal, Kathmandu-11, Kathmandu

Subject : Submission Of Final Survey Report

Dear sirs,
Acting upon your instruction verbal dated 07/07/2019 to carry out survey of above mentioned
vehicle,we duly conducted the survey.This report is delayed due to late submission of claim
documents by the insured,we received claim documents from insurer on 01/09/2019.Now, we are
submitting the survey report along with the following documents:

1. Survey Report …………………………………1

2. Professional fee bill …………………………………1
3. Photographs …………………………………10

Insured : Nityam Traders

A/c : Avdesh Kumar Sah
Policy No. : HTD/18/19/MCY/00067
Claim No. : C10474/075/076
Date of Loss : 3/11/2076

1. Preamble:
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.

2. Insurance Policy Detail :

S.N Particulars Value
1 Insurer Siddhartha Insurance Co. Ltd
2 Insured Nityam Traders
3 A/c Avdesh Kumar Sah
4 Policy No. HTD/18/19/MCY/00067
Type of
5 Policy Comprehensive
6 Endorsement NN/A
Period of
7 Insurance 05/03/2019 to 04/03/2020
8 Risk Covered
9 Type of VehiclPersonal
Declared
Value (With
10 breakdown) 259,900.00
11 Excess
Compulsory 500.00
Voluntary 2,000.00
12 Remarks

Page 2 of 10
Er.Bishworam Parajuli Lalitpur-28, Lalitpur License no. 852/074/075
3. Particulars of Vehicle:
S.No. Particulars Insured Vehicle Third Party Vehicle
1 Registration No. NA 65 PA 2198 BA 70 PA 9985
2 Date of Registration 15/11/2075 5/6/2072
3 Chassis No. MD2A11CY4JCH93079 MD2A13EZ1FCE48858
4 Engine No. DHYCJH22715 DKZCFE36740
5 Make and Model Pulsar 150 Pulsar 220
6 Type of Body Factory Made Factory Made
7 Year of Manufacture 2019 2015
8 Capacity (HP or C.C) 149.5 CC 220 CC
9 No. of persons permitted 2 2

4. Particulars of Driver:
S.No. Particulars Insured Vehicle Third Party Vehicle
1 Name and Address Abadhesh Kumar Sah Raj Kumar K.C
2 Liscence No. 01-06-00640183 01-06-00432263
3 Type of Licence A B/A
Ministry of Physical Ministry of Physical Infrastructure &
4 Issuing authority Infrastructure & Transport
Transport
5 Date of Issue 28-04-2019 31-07-2017
6 Validity of Licence 30-07-2022
7 Remarks

5.Details of Accident:
Date and time of Accident 2076-03-11 , 9:15
Place of Accident Gwarko,Lalitpur

Cause and Nature of Accident Collision of two vehicles due to not management of breaking
distance.
Police Report / FIR (First
Intimation Report)
When the accident was
i
Reported to the Police:
Name of the Police
ii
Station:
iii Police Station Diary No:
Final Report of Police(If
iv
Applicable) :

Media Report (If Any)

Page 3 of 10
Er.Bishworam Parajuli
6.Survey Investigation
Date of Allotment of Survey
Date & Time of Survey
Contact Person (S)
Inquiry & Discussion
Descreption of Incident
Cause of Incident
Action taken to minimize the the
loss
Details Provided by the Eye
witness (If any)
Findings
Lalitpur-28, Lalitpur License no. 852/074/075
3/17/2076
3/22/2076
Abadhesh Kumar Sah
Acording to the version of insured representive the vehicle was
travelling to balkot from balkhu.All of sudden the vehicle lost it
control at Gwarko and collided with Third party Vehicle(Ba 70 pa
9985).Thus insured vehicle and Third party vehicle both got
damaged.
Short breaking distance
Due to accident the insured vechicle and third party vehicle got
damaged.

7.Description of Loss/Damage/Expenses Injury:

Due to collision of two vehicles parts of the vehicle was
a) Own Damage
damaged.
b)Third Party
i) Vehicle Damage Parts of the vehicle was damaged .

ii) Other Property Damaged N/A

Insurer Abadhesh Kumar and Third party person Raj Kumar K.C
Bodily Injury & or Death
both were injured and treatment is done at B&B hospital Gwarko.
iii)

8.Details of Loss Assessment

LOSS ASSESSMENT IN DETAIL
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 Leg Guard 1 Pc 1,500.00 1,500.00 -
2 Axle Rod 1 Pc 309.73 309.73 300.00
3 Cone Bearing 1 Pc 871.68 871.68 750.00
4 Handle Holder Rh 1 Pc 889.38 889.38 700.00
5 Grab Handle Lh 1 Pc 477.88 477.88 400.00
6 Master Cylinder 1 Pc 2,500.00 2,500.00 2,000.00
7 Handle LH 1 Pc 566.37 566.37 500.00
8 Handle RH 1 Pc 566.37 566.37 500.00
9 Silencer Assembly 1 Pc 11,500.00 11,500.00 10,000.00
10 Cover Startor 1 Pc 132.74 132.74 100.00
11 Bearing Ball 2 Pc 221.24 442.48 400.00
12 Nut U Swing 1 Pc 70.80 70.80 70.00
13 Lamp Shade 1 Pc 1,039.82 1,039.82 900.00
14 Tank Flap RH 1 Pc 902.65 902.65 900.00
15 Shock Assembly 1 Pc 15,862.83 15,862.83 15,000.00
16 Bolt Flanged 2 Pc 30.97 61.94 60.00
17 No Plate 1 Pc 110.62 110.62 -
18 Mirror LH 1 Pc 389.38 389.38 300.00
19 Disc Plate 1 Pc 3,230.09 3,230.09 2,800.00
Sub-Total 41,424.76 35,680.00
Depreciatation for below 6 monts Vehicle - 0
Amount after depreciatation 35,680.00
Less Salvage Value 10% 3,568.00
Amount After Salvage NRs 32,112.00
VAT 13% 4,174.56
Sub- Total (a) [In NRs] 36,286.56

Page 4 of 10
Er.Bishworam Parajuli Lalitpur-28, Lalitpur License no. 852/074/075
b. All types of Rubbers,Lights,Batteries,Tyres & Tubes items:

S.No Claimed
Particulars Qty Unit Rate Amt. Assessed Amt. Remarks
1 Grommet 1 Pc 17.70 17.70 15.00
2 Indicator 1 Pc 424.78 424.78 350.00
3 Screw Mush 4 Pc 13.27 53.08 50.00
4 Tail Lamp 1 Pc 1,694.69 1,694.69 1,500.00
5 Indicator 1 Pc 420.35 420.35 350.00
6 Brace Fender 1 Pc 451.33 451.33 350.00
7 Decal Seat cowl 1 Pc 513.37 513.37 450.00
8 Switch Brake 1 Pc 185.84 185.84 150.00
9 Control Switch 1 Pc 1,230.09 1,230.09 1,000.00
10 Seat Cowl 1 Pc 2,323.01 2,323.01 2,000.00
11 Tank Flap RH 1 Pc 902.65 902.65 800.00
Sub-Total 8,216.89 7,015.00
Less 50% 3,507.50
Amount after Depriciation [In Nrs] 3,507.50
VAT 13% 455.98
Sub-Total b [In Nrs] 3,963.48
Total of A (a+b) [In NRs] 40,250.04

B.Labour Charges
S.No Claimed
Particulars Qty Unit Rate Amt. Assessed Amt. Remarks
1 Rim Repair 1 3,500.00 3,500.00 3000
2 Chasis Repair 1 8,000.00 8,000.00 7000
3 Labour Charge 1 5,000.00 5,000.00 3000
4 Tankey Repair 1 5,500.00 5,500.00 4000
Total 22,000.00 17,000.00
VAT 13% 2,210.00
Total of B [In Nrs] 19,210.00
Total Loss Due to Accident "A+B" [In NRs] 59,460.04

Page 5 of 10
Er.Bishworam Parajuli Lalitpur-28, Lalitpur License no. 852/074/075
Loss Assessment of the Third Party Vehicle
A. Parts &Accessories Loss Assess Details:
Claimed
S.No Particulars Qty Unit Rate Assessed Amt. Remarks
Amt.
1 Air Intake LH 1 Pc 101.77 101.77 90.00
2 Air Intake RH 1 Pc 101.77 101.77 90.00
3 Head Lamp Assy 1 Pc 7,725.66 7,725.66 6,500.00
4 Handle Holder Rh 1 Pc 889.38 889.38 700.00
5 Frame Fairing 1 Pc 4,070.80 4,070.80 3,500.00
6 Fairing 1 Pc 6,991.15 6,991.15 6,000.00
7 Nut Well 6 Pc 30.90 185.40 180.00
8 Screw SS 6 Pc 13.28 79.68 60.00
9 Bulb H/L 2 Pc 761.06 1,522.12 1,300.00
10 Wind Shield 1 Pc 646.02 646.02 500.00
11 Indicator 1 Pc 420.35 420.35 300.00
12 Grab Handle 1 Pc 477.88 477.88 300.00
13 Chain Sprocket 1 Pc 3,646.02 3,646.02 2,500.00
14 Handle RH 1 Pc 566.37 566.37 500.00
15 Handle LH 1 Pc 566.37 566.37 500.00
16 Master Cylinder 1 Pc 2,500.00 2,500.00 2,000.00
17 Silencer Assembly 1 Pc 30,287.61 30,287.61 20,000.00
18 Shock Assembly 1 Pc 16,123.89 16,123.89 12,000.00
19 Cone Bearing 1 Pc 871.68 871.68 800.00
20 Brace Fender 1 Pc 362.83 362.83 300.00
21 Bearing Ball 2 Pc 221.24 442.48 400.00
22 Disc Plate 1 Pc 3,230.09 3,230.09 2,000.00
23 Wheel Rim 1 Pc -
24 No Plate 1 Pc 110.62 110.62 -
25 Axle Rod 1 Pc 353.98 353.98 300.00
26 Nut U Swing 1 Pc 70.80 70.80 70.00
27 Mirror RH 1 Pc 809.73 809.73 400.00
28 No Plate Bkt 1 Pc 221.24 221.24 -
29 Shock Assembly 2 Pc 2,451.33 4,902.66 -
30 Meter Cover 1 Pc 973.45 973.45 700.00
31 Handle Holder 1 Pc 867.26 867.26 700.00
32 Valve Tubeless 1 Pc 88.49 88.49 -
33 Kit Hardware 1 Pc 128.32 128.32 -
34 Kit Bracket 1 Pc 176.99 176.99 -
35 Tyre MRF 1 Pc 2,566.37 2,566.37 2,000.00
36 Grab Handle 1 Pc 477.87 477.87 400.00
37 Switch Oil Pressure 1 Pc 358.41 358.41 300.00
38 Fuel Tape 1 Pc 477.88 477.88 400.00
39 Shield Cot 1 Pc 176.99 176.99 100.00
40 Guard Pillion 1 Pc 305.31 305.31 200.00
41 Screw 2 Pc 22.12 44.24 40.00
42 Nut U Swing 1 Pc 57.52 57.52 40.00
43 Tyre Liquid 1 Pc 450.00 450.00 -
44 Leg Guard 1 Pc 1,700.00 1,700.00 -
45 Wheel Rim 1 Pc 8,898.23 8,898.23 7,500.00
Total 106,025.68 73,670.00
Salvage Value 10% 7,367.00
Sub-Total After Deduction [In NRs] 66,303.00
VAT 13% 8,619.39
Total Of A [IN NRs] 74,922.39

B. Labor Charge Details:

Claimed
S.No Particulars Qty Unit Rate Assessed Amt. Remarks
Amt.
1 Chasis Repair 1 Pc 8,000.00 8,000.00 6,000.00
2 Labour 1 Pc 6,000.00 6,000.00 4,000.00
Sub-Total 14,000.00 10,000.00
VAT 13% 1,820.00 1,300.00

Page 6 of 10
 Total Of B [IN NRs]
Er.Bishworam Parajuli 15,820.00
Lalitpur-28, Lalitpur 11,300.00 License no. 852/074/075
Total Loss of Third Party Vehicle Due to Accident "A+B" [In NRs] 86,222.39

Page 7 of 10
Er.Bishworam Parajuli Lalitpur-28, Lalitpur License no. 852/074/075
9. Insurer's Liability

The entire total loss due to accident is assessed NRs. 59,640.00 [In Words: Fifty Nine thousand Six
Hundred Forty only.] out of Quoted Amount NRs.: 80,955.00 [In Words: Eighty Thousand Nine
Hundred Fifty five only.] of Insured vehicle and total loss of the third party property damaged due
to accident is assesed NRs: 86,222.00 [In Words: Eighty Six Thousand Two Hundred Twenty Two
only.] out of Quoted Amount NRs. : 1,35,629.00 [In Words: One Lakh Thirty Five Thousand Six
hundred twenty nine only.].

The assessed amount will be the liability of the insurer after deducting compulsory and voluntary
excess against the property damage of insured vehicle and the third party property damage.

10. Supporting Document

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. The supporting
documents provided by the insured is attached in the report which are as follow:
a)      Accident notification application copy with claim form registered on Siddhartha Insurance
Limited, (Registration no. C10474/075/076, Date: 2019/7/02, Time:……………..)
b)      Copy of insurance policy.
c)      Copy of Vehicle Registration Certificate of insured vehicle and third party vehicle.
d)      Copy of Driver’s licence of insured vehicle driver and third party vehicle driver.
e)      Copy of Citizenship Certificate.
f)      Estimate of the insured vehicle and third party vehicle.
g)      Original bill from Shree Ganapati Enterprises, Balkhu, Kathmandu. PAN no: 600971102, Bill
No. 039,041,042,043,036,035,037, and 044 with total amount of 2,12,499.92.

11. Photographs
All the Photographs are attached herewith in the annex 1 of the report.

12. Conclusion
The assessment was thoroughly discussed with representative of the insured. The above calculation
of insured’s liabilities were discussed with Representative Mr. Avdesh Kumar Sah. The following
other terms have also been agreed to on behalf of the insured.
a)      Production of relevant documents as may be asked by the insurer.
b)      Permit re-inspection of the above vehicles if required.
c)      No Submission of any supplementary estimates.
d)      Agree to preserve the salvages until the settlement of the claim.
Declaration: Keeping in view of the version of the claimant and having carful examined the
damages thoroughly and investigating about the accident, we are of the opinion that the damages of
insured vehicle and Third party vehicle are due to the accident and are practical in nature. The
extent of damages mentioned above conforms to the nature of the incident as described to us.

Signature:
Name: Er. Bishworam Parajuli
License No.: 852/074/75
Date: 2076/05/01

Page 8 of 10
S.No
Particulars Qty Unit Rate Claimed Amt. Assessed Amt.
Claimed Assessed
S.No Remarks
Particulars Qty Unit Rate Amt. Amt.
1 Air Intake LH 1 Pc 101.77 101.77 90.00
2 Air Intake RH 1 Pc 101.77 101.77 90.00
3 Head Lamp Assy 1 Pc 7,725.66 7,725.66 6,500.00
4 Handle Holder Rh 1 Pc 889.38 889.38 700.00
5 Frame Fairing 1 Pc 4,070.80 4,070.80 3,500.00
6 Fairing 1 Pc 6,991.15 6,991.15 6,000.00
7 Nut Well 6 Pc 30.90 185.40 180.00
8 Screw SS 6 Pc 13.28 79.68 60.00
9 Bulb H/L 2 Pc 761.06 1,522.12 1,300.00
10 Wind Shield 1 Pc 646.02 646.02 500.00
11 Indicator 1 Pc 420.35 420.35 300.00
12 Grab Handle 1 Pc 477.88 477.88 300.00
13 Chain Sprocket 1 Pc 3,646.02 3,646.02 2,500.00
14 Handle RH 1 Pc 566.37 566.37 500.00
15 Handle LH 1 Pc 566.37 566.37 500.00
16 Master Cylinder 1 Pc 2,500.00 2,500.00 2,000.00
17 Silencer Assembly 1 Pc 30,287.61 30,287.61 20,000.00
18 Shock Assembly 1 Pc 16,123.89 16,123.89 12,000.00
19 Cone Bearing 1 Pc 871.68 871.68 800.00
20 Brace Fender 1 Pc 362.83 362.83 300.00
21 Bearing Ball 2 Pc 221.24 442.48 400.00
22 Disc Plate 1 Pc 3,230.09 3,230.09 2,000.00
23 Wheel Rim 1 Pc -
24 No Plate 1 Pc 110.62 110.62 -
25 Axle Rod 1 Pc 353.98 353.98 300.00
26 Nut U Swing 1 Pc 70.80 70.80 70.00
27 Mirror RH 1 Pc 809.73 809.73 400.00
28 No Plate Bkt 1 Pc 221.24 221.24 -
29 Shock Assembly 2 Pc 2,451.33 4,902.66 -
30 Meter Cover 1 Pc 973.45 973.45 700.00
31 Handle Holder 1 Pc 867.26 867.26 700.00
32 Valve Tubeless 1 Pc 88.49 88.49 -
33 Kit Hardware 1 Pc 128.32 128.32 -
34 Kit Bracket 1 Pc 176.99 176.99 -
35 Tyre MRF 1 Pc 2,566.37 2,566.37 2,000.00
36 Grab Handle 1 Pc 477.87 477.87 400.00
37 Switch Oil Pressure 1 Pc 358.41 358.41 300.00
38 Fuel Tape 1 Pc 477.88 477.88 400.00
39 Shield Cot 1 Pc 176.99 176.99 100.00
40 Guard Pillion 1 Pc 305.31 305.31 200.00
41 Screw 2 Pc 22.12 44.24 40.00
42 Nut U Swing 1 Pc 57.52 57.52 40.00
43 Tyre Liquid 1 Pc 450.00 450.00 300.00
44 Leg Guard 1 Pc 1,700.00 1,700.00 -
45 Wheel Rim 1 Pc 8,898.23 8,898.23 7,500.00
Total 106,025.68 73,970.00
Salvage Value 10% 7,397.00
Sub-Total After Deduction [In NRs] 66,573.00

1 Chasis Repair 1 Pc 8,000.00 8,000.00 6,000.00

2 Labour 1 Pc 6,000.00 6,000.00 4,000.00