Ankit Sahu - Uiic - M75 - Report Revised On Repair Basis - 31.07.2023
Ankit Sahu - Uiic - M75 - Report Revised On Repair Basis - 31.07.2023
Ankit Sahu - Uiic - M75 - Report Revised On Repair Basis - 31.07.2023
3 Driver's Particulars:-
(a) Name of Driver & Add. : Mr. Ankit Sahu S/o Shri Tikaram Sahu R/o Jabalpur M.P.
(b) MDL No. : MP20N-2011-0317724 (DOB - 31.05.1986)
(c) Date of Issue : 06.09.2011
(d) Valid Upto : 05.09.2031 w.e.f. 06.09.2011
(e) Issuing Authority : RTO (LA) Jabalpur (M.P.)
(f) Type/Authorized to Drive : Permanent, Auth. To drive MCWGR, LMV-NT only
Also Downloaded from MP Transport & Parivahan (Govt. of India)
(g) Badge No./Endorsements :
Website
4 Accident Particulars :-
(d) Date & Time of Survey/AT : 13.03.2023 onwards at Dealer's workshop, Jabalpur
5 Details of Survey : Pursuant to the instructions received from UIIC Portal, the
undersigned carried out the survey of the subject vehicle at Dealer's
workshop Jabalpur, along with Insured. Details are as under:-
(a) Spot Survey Details : Not held, however insured had arranged few photographs of the
vehicle at Spot which are furnished and enclosed.
(b) Police Report / Notifications : Matter was intimated to PS Gadasarai, Distt. Dindori on 03.03.2023
and police has duly acknowledged the insured's intimation and
entered the matter in Station Diary No. 168 dtd. 03.03.2023 and
released the vehicle without taking any action. (Copy enclosed)
(c) TP injuries/Ppty/ Damages : Reported - Nil
(d) Details of Load Challan : NA
(e) Occupants/Injuries etc. : Only Driver (i.e. insured himself) - not injured
(f) Verification of Documents : All have been verified from original & found in order.
(g) Details of Estimate etc. : M/s Frontier Motocorp, Jabalpur Est No. JC-KP1-2223-003418 dtd.
04.03.2023
(h) Cause & Nature of accident : As per the statement mentioned in the claim form/ Police Intimation
and as revealed from the driver (i.e. insured himself), that the vehicle
was going through aforesaid area, on the way nearby aforesaid spot,
at turning vehicle suddenly went out of control and further fell/
overturned / turned turtle at the road side ditch, causing the relevant
damages.
(SANJEEV AGRAWAL)
SLA-4925 (Val.09.08.2025)
Sanjeev Agrawal (SLA-4925)
Insured : Mr. Ankit Sahu S/o Shri Tikaram Sahu Vehicle No. : MP20CH5660
Policy No. `0209003122P104658336 (0% Depn. Policy) Date of Reg. : 30.08.2018
Validity 23.08.2022 to 22.08.2023 Date of Acc. : 03.03.2023
Age of Vehicle on Date of Accident : Exceeding 1 yr but not exceeding 2 yrs
Excess (Re): 1000
0% : Rubber/Plastic 10% :Metal 0% : Glass
"R" Not Marked "G"
(SANJEEV AGRAWAL)
SLA-4925 (Val.09.08.2025)