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Familiarisation Course On Marine Claims

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Familiarisation Course On Marine Claims

  1. 1. DISTRIBUTION COMPANY LIMITED MUMBAI ltlARINE CLAIMS . FAMiLIAR/SA TlON ON THE !lfAJVDA TOR DOCUME1VT A TIONS TING EXPEDII10US OF CLAlkfS BYTIlE lVEW INDIA ASSURANCE C01}1PANY LTD ************************
  2. 2. TMLDC LTD, MUJV1BAl IMANDA TOR y DOCUMENTS(j. Check Sheet -forwarding lettere Carbon copy (~rE!(dse CIUlllan cum Sales Invoice" Carbon copy of G; CIL. R.lR.R Note• Hnvers statement in originaleEJ,tinUlte in original" Claim Bill in duplicate" Copy (~lIYl()nitor.vNotice 011 the Carrier (Transporter)" Surveyor Report with Survey Fee ReceiptOJ Photographs Certificate ji-onl the Carrier Bii/( Invoice)• { .WI1tl Form du(v filled in (lnd signed Spot Surve.v Report and Photographs (in case of enroute major accident)" .4 letter to requesting them to settle the claim on Total Basis Subrogation ofAl/orney ( el."Ie extract of the Board Re,iwlution )
  3. 3. Covering letter on the Letter head of the dealerThe Insurance Cell,TMLD Co.Ltd.,1, Forbes, 4th Floor,Dr: V. B. Gandhi Marg,Fort, Mumbai 400 001Sub: Marine Insurance Claim in respect of vehicles bearing Chassis No/Nos .Dear Sir,We forward herewith the following documents in respect of vehicles mentioned above forsubmission to NIA and settlement. Please tick the documents enclosed: 1. Excise Challan - cum -Sales Invoice No dated (original/carbon copy to be enclosed. ) 2. G. C. Note/RRlLR No dated ( carbon copy to be enclosed) 3. Driver Report (in original on a plain sheet with his signature & Name) 4. Estimate ( in original) 5. Claim Bill ( in duplicate, in original and on the letter head) 6. Monitory Notice on the carrier ( copy) 7. Survey Report and fee receipt in original 8. Damage Certificate 9. Claim Form ( duly filled in and signed - in original) 10. Photographs 11. Final Repair bill ( tax bill in original) 12. FIR, Spot Survey Report and Photographs (whenever vehicle meets with major accident en-route) 13. Letter addressed to New India ( in case of total loss - stating that the claim may please be settled on total loss basis) 14. Letter of subrogation (for total loss only) along with a copy of the Power of Attorney of the signing authority.Thanking you,Yours faithfully,Name of the organization, signature, Name of the signatory, and Designation.
  4. 4. Ref No: Oate:20/05/2009ToInsurance Cell,Tata Motors Ltd.Passenger Car DivisionWorld Trade Centre, Centre-126m Floor, Cuffe ParadeMumbai 400005Sub: Ex works Sale Vehicle Marine/Motor Insurance ClaimChassis no(s) MCA11071709003697CQZDear SirWe forward herewith the following documents for the purpose of claim undertransit insurance policy of Indica Car:Please tick only on the documents enclosed[5( Excise Challan cum Sales Invoice 971776690 / dated 15103/2009[3 Original GC Notel Bilti No. 12466 dated 16/03/2009o )3urvey Report and Survey fee receipt in original5t yOpya:r Ack. of monetary notice Le. carrier of delivery in form of Registered of monetary notice to proof in original Post AD yard stamped and signed by the transporterf3Ypamage Certificate in Original.~~Iaim Bill in duplicate.g19fiR and Spotinsurvey report if applicable. Claim Form original~fhotograph and negativesgr Drivers Statement in original & copy of his license.D Final Repair Bill in original (only for Repair Claims)(i:( Letter~..Repair of total loss original (for all claims) Estimate ino Letter of subrogation (for total loss claims)ORe-inspection report (for motor claims only)Please take our claim with New India Assurance Co. Ltd. for Rs. 701151.88Thanking You.Yourstp~For C~c;rde Motors (India) Ltd .Mr. KarpppasamyBusiness Unit l-lead, Cochinkaruppasamyk@concordemotors.com
  5. 5. .~ HO RVI SEV.A Offices MIs. TATA MOTORS LTD. Pimpri, Pune - 1 018 No·1 46 No. : REMARKS Kms. For Kishor Transport Services Pvt Auth.1) Received goods enlirelV at OWNERS RiSK as delgH" above for carriage end tills ConsJgnmerr! note is Issued ~ Contract2) The consignor expressly declares that above him sand di:scrtptio,,1S in bool,5 of account other related documents are in the terms and conditiorrs of ontriilc! which has read and I or explakned and a<X"..apts his agimt who hi." full power and light 10 book tile goods • forwarding note, receipts on
  6. 6. ORIGINAl. 90110!3862621.fH.2G09 ~e.lers PDUeb-GrD~tr-OR09-00/14. en.( ) GRI.1IJER TRAf)[ CHileS f ,M1f{EIlL V Gm.tR TRAOCI..1}Ij(S M LID 4TH I[I!.ISTM ~ tnll) Shp 00 3835S [ffl !1INI rrrt PASS I BE 0106585 ~T 01.0S.06 BE 5050795 f)T 15.05.06 f.lACCG:!066& Gr:IJI.IER1m 1 L.:00i8 M fJi) 4TH m:tETM I~ mAl) , lab IndIca Mrt:. <GLS) !flIt! m1f Jjjtl1 A.G. UnIt, FOller ~t*iering, "1753I f.ngitie. <Ifni (1£ ill, 63!f,1l9a CC, (r.m-w. -PE1T{(l! LPG) T1ans<IXJ~ I !nios. t.1hf.<ll Ri11S, S Has. 16S165R 13 !{<tdi<ll lyres, 2400 rtlLt R SeaUIgC.pwity"II Drive!. CololJf : I1etallic MGr£-,tIJREi . O~si~ Value (Rs.) 2"1;;; 2;H " 1:3 lefts Dlscount (Rs.) 16.409,[32 Subtot.l (Ri>.) ::~5S.B2L 31 R!)(: (RI>.) 8.68)1,00 HlHtL (Rs.) c!64. ~:;10,31 vAT 8 12.5~ nR CST e 1~ (Rs. I S. 116, 4~j GRIIMI> nlTAL Hh.) 269.626,74
  7. 7. Driver Report on a plain sheet of paper DRIVER REPORTName of the Driver(full name as appearing in theDriving licence)Full Address(As appearing in the driving licence)Licence Details of the Driver:Licence No.Date and Place of IssueDate of ExpireyAccident DetailsDate and Place of Accident( with District & State)Transporters name, address andTelephone/mobile No.Short description of the accidentand the damages sustained to theVehicle/vehiclesPlace:Date: (Name of the driver & his signature)
  8. 8. Drivers Report.Name of Driver J"..d..<3lfrCL O~d;,)7o..{<::.t:?u..- t-:5C1Pt"tJLcffJ;YlAddress , "l.:::J:.(. t<,pf.y~l4..." Df:;X- ~ Eeef!ct)!( Ka,.7 v...Jq.l=- ~) PvtTransporters Name & Tel. No. : r.{~7Truck No :K (~Licences DetailsLicence No.Date & place of issueDate of expiryAccident DetailsDatePlace of accident(with District & State)Cause of AccidentChassis No !to?( 76 7 Z~Engine No : (!)C; ( 6 5"" D gModel & Colour : f ~ •• - ~ .. D1. /V~co1 ~?tdDamage due to the accidentSignature of driver or transport contractor GWNDfrA(Name: 63tJw,~l)Date: 4.
  9. 9. ONCORDE PassengerCarDea~r - -- I «- _ 1~~.--- --- - ---- --~._.- -.- -.-----«-« ---~-----_. --".--,. 645 , 9001 416851 3500 1500[ 1r-~ REAR BUMPEI~ 45 GARNISH RH 1-. GAS 57!).----< 136~~~AT WITH , TUBE 46900<- FRONT ALIGNMENT TYRE <REA~<B<~1£..ER -~ --j-- WHEELSUSPENSION I ___ 531851 58 EtJ_GINE R&RELEC!.BICAI._ & I _____ : NCI£:EL .. DISC _ A~.§.L_.< f~OO • 2100 66000 5000 1500 5001 -< II [500 400 7.00, f--------=:;l 2325 5781 2325 1744 507 ! -.,--,- __ I I 2500 540 1940 6600 I 1500 1951 -2l.t!Q ~j----!=----GRiLL 38<KNl!~KLE BEARING .. -~ Terms &. Conditions 1 Payment of Ihe liU is to be done by the customer and the ,ame may be 3ubscQucntfy claimed from the ins.ursncc company. In ca-se of cashles..s insurance products. cashless ru!es apply <.. 2 This is coly a preltminary eslimate and actuaf i1fficunt will vary as p-er the ••. involved o.-x 3 Taxes will hi-: Axtra & willtJe indudAr! in the final hi!! of repairs 4 Delivery against payment by casrl/DD In case norma! poricles I Ncar cashJoss rules In case of near cashless policios. Your are reQUested to ~:ect a!llhe removed parts/Salvage althe time of !he dE:livery of your vehicle. If not colJected the same cannot be plOvided r:J1 1-1 !dCf t1ulc Picaso feci free to call on uS tor any danflCabO!1 r-r.VARAOARAJ~ Iii! De pleased to oe of help. ;ssuring yo~ of our best ottenf1on Thanking You Yours. faithfully, ~f~, Body ShO~ ~~- CDPcorde Motors ( India) Limited :.;n;:J%Subs.;d;a:y of TiIA Motors Ltd.) 15;62/1 NeHny t/W5G,i P;:::nch~Y3t!;::GC·11!). Emdkuttii,l District Kefa!H - 682304. Showroom _Tei. 0484-5602000101/02i03 Service _ 66020iOIiI112!i:! , .":1~ . S2!es ?j-::h:~:~:o!corde;-:-,oto"~..:0:: Se"JfCc.~:)cni1@CDncordematofs.ccm Weh;iie: .COilcorden1otors.com if Rfl£.;t:L Ofhcf: . 3rd FeeL ;"~3naV.1~:M8 -;f1:?Y~ 13. H,.Y:ii M!)d; S:reet, i-tua~ma·Ci1Cwk. t•• 1umbal· 400 001
  10. 10. On the letter head of the dealer CLAIM BILLInvoice No/Nos . Date: .G.C.Note/RRILR No . Date: .From: . To: .Name of SurveyorA. Assessed Amount Rs .(the amount should be for all the vehicles) <B. Survey Fee Paid Rs .C. Total Claim Amount Rs ( A + B)D. Less: Salvage as assessed by the surveyor Rs .E. Net Receivable Rs ( C - D)Date:Place: Signature of the claimant Name: Designation Name of the dealership
  11. 11. Enclosure A3 Standardfo[mat of Claim Bill New India Assurance Co. Claim Bm Invoice No. 971776690 Date 15/03/2009 GC Note No. 12466 Date 16/03/2009 From Pune To Cochin Surveyor Mis _ A. Assessed Amount: Rs. 701151.88 B. Survey Fee Paid Rs._2500 __ C. Claim Amount Rs. _703651.88 (A+B) Salvage as assessed by surveyor Rs. Not applicable being Total Loss (Salvage to be deducted only in repair cases) E .. Net Receivable Rs. 703651.88 (C-O) Date: Place: Cochin Signature of Claimant For Concorde Motors (India) Ltd Mr. Kamppasamy Business Unit Head cochin ----~ _--",-----_._--_. .~----_ .•.. ..... I<:erala· 682 30<1. 6602010111/12113E-i"fiail . SaLe:;.coc.hm4YCOhcordemotcfS.(;{)ff1, Service.cochrn@concordeTHotors.Gorn. Website: Wvw.concordemotors.com Ofik" : 3rd Floor, Nanavet! Mahaiaya, 18. Hom, Modi Strl>el. Huatma·Chowk. Mumbai . <100001
  12. 12. Monitory Notice on the Transporter to be on the dealers letter headRef. No. Date:To:Name of the transporterFull addressDear Sir,Sub: Claim for the damage to consignment of G.C. Note/RRJLR No dated .Please take Notice that (indicate the no.) vehicles ( cars/MUVs) weretransported from (place) to (place)under your above mentioned G.C.Note/RRJLR No.___ vehicle(s) out of the same consignment were delivered to us in externallydamaged condition/have not been delivered. Relative GC/RRJLR note has been qualifiedto that effect while taking the delivery. The concerned driver of yours hasappended/refuse to append his signature thereto.Chassis No. Description of damages Amout Repair/Total lossPlease issue immediately, your regular damage certificate. Please also depute yourrepresentative to assess the exact loss as we are also arranging the insurance survey. Inthe event of your not deputing your representative simultaneously, the loss assessed bythe Insurance Surveyors, who are Govt. Licensed surveyors, will be finally binding onyou.Please register our claim for Rs (Total Amount as above )and settle it without any loss oftime.Thanking you,Yours sincerelyName of the dealership,SignatureName of the signatory
  13. 13. CONCORDE Passenger Car Dealer Enclosure A2 Standard Format of Monetary Notice to Transporter By Regd. Post I Hand Delivery Ref No. 0001 Date 13/04/2009 To Klshore Transport Services Pvt. Ltd. Office 73& 74, Co win c/, 1 st Floor, Purnanaqar Commercial Complex, Chinchwad, Pune - 19, Tell fax-020-27493234, 27494752153 Sir Sub: Claim for the damage to consignment of GC No. 12466 Dated-16/03/2009 Please take Notice that MCA11071709003697CQZvehicie (cars I MUVs) were transported from Pune to Cochin under your above mentioned GC Note. 12466 vehicle(s) out of the same consignment were delivered to us in externally damaqed condition / have not been delivered. Relative GC/LR note has been qualified to that effect while taking the delivery. The concerned driver of yours has appended/refuse to append his signature thereto. Damage --- Amount Chassis No. MCA 11071709003697CQZ ~ BODY SHELL DAMAGE I ! I 701151.88 ·---1 ---1 I I -----l (TOTAL LOSS) ! Please issue immediately, your regular damage certificate. Please also depute your representative to assess the exact loss as we are also arranging the insurance survey. In the event of you not deputing your representative simultaneously, the loss assessed by the insurance surveyors, who are Govt. licensed surveyors, will be finally binding to you. Please register our claim for Rs. Seven lakh One Thousand One Hundred Fiftv One and settle it without any loss of time. Thanking you, Yours truly For Concorde Motors (India) Ltd y Mr. Karuppasamy Business Unit !lead Cochin CC: (Transporters corporate office) Insurance Cell, Tata Motors Ltd. Mumbai.Concorde Motors {India} Limited (100% Subsidiary ofTATA Motors Ltd.)I: 10, 2561C, Survey No. 156211. Nettoor, Marariu Panchayath, Cachiri, Ernaku!am District. Kerala _ 682 304.Showroom: Tel: 0484-6602000!01i02103 Service: Tel: 6602010/11112113[-mail: Saies.ccchin@concordemotors.com.Service.cochill@conCOrdemolors.com.Webslte:wwl.concordemotom.comRegd. Office: 3rd Floor. Nan3vac Maha!aya. 18. Horr.; "".odl Slreei, Huatma ChOl/«, Mumbai - 400 001
  14. 14. A. K. MATHUR Insurance Surveyor SLA-5521 Valid upto 26-02.2012 MARINE SURVEY REOPRT 05.05.09.To,The Divisional Manager,The New India Assurance Co. Ltd.,Divisional Office,Pune. Ref- Transit claim invoice no. 9011088626 dated 21.03.09 from Mis TATA Motors Ltd. Pune, to Mis Grover Trade Links (P) Ltd., Bareilly. (U.P.)As pcr request of Grover Trade Links (P) Ltd.,(Auth. Dealer) Bareilly to con-ducltbe survey & to assess the loss s1,Jffered by insured due to damages to Tatas IndicaXeta car bearing Chassis No. 600731BOZP13963 Details of Survev are as follows:-1. Name of consignor M/S.T.M.L. Distribution Company Ltd. Pimpri . Pune.2. Name of Consignee Mis Gtover Trade Links {PI Ltd., 4tJ• KM, Rampur Road, C.B. Ganj, Bareilly. Bareiny.3. Name of Insurer The New India Assurance Co. Ltd., Pune.4. Name of Insured Mis T.M.L. Distribution Co. Ltd" Pune.5. Name of the Carrier MI s Delhi Gujrat Fleet Carrier, Shop. No.-48, Jija Mata Market, Behind HDFC coJony, Shahu Nagar, MIDC. Chinch wad, Pune.8. Truck No. HR-47-8820.9. Consignment Note No. 25834 dt 21.03.09.10. Place of Despatch Pune.11. Place of Destination BareiUy. (U. P,)12. Date of Despatch 21.03.09.13. Date of Delivery 26.03.09.14. Date of Survey 27.03.09. onwards.15. Place Survey At the godownl workshop of MI s Grover Trade links Pvt. Ltd., Bareilly. Residence: 92, A vas Vikas Colony, Behind Bareilly Club, Hareilly - 243 (){}! Office: Anand Ashram Complu, Ramplir Garden, Haremy -243(}f)1 (Is, Dr V K Chawla} Mobile: 9&370 - 53743 Office: 0581-2453248 Resi: 0581·2428505
  15. 15. 2 A. K. JYIATHUR Insurance Surveyor SLA-5521 Valid upto 26-02.201216. Natq.te Goods Carried 3 Nos Tata Indica and 2Nos. TATA Safari were dispatched in the trailer.17. Nature of packing The vehicles were dispatched in covered trailers properly tied/parked in slots exclusively designed for transportation of motor vehicles.18. Nature of loss afterExamination attributed to One No. TATA Indica was damaged from front portion, damaging front bumper and sun shade(delivered in damaged condition from the facLOry).19. Invoice No. & Date Invoice No. 9011088626 dl. 21.03.09. fO! Rs.2,69,626.74.20. Notice To Carrier A Regd. Notice has been given to the carrier claiming a monitory compensation ofRs.4000/-.21. Shortage/Damage Certificate The consignee has obtained a damage certificate from the driver Shri Mahavir Singh of truck no. HR-47-8820.22. Obeservation & findings A consignment of 3 Nos TATA Indica and 2 Nos Tata Safari were booked from Pune to Barei1ly by road in trailer No. - H]~-47- 8820 vide sale invoice No. 9011088626 dt 21.03.09, c/note no. 25834 dt 21.03.09. During transit due jerks &jolts the frontal portion of one of the Indica was bmshed/impacted/damaged and needed replacements/repairs. The photographs of the vehicle were arranged The consignee has obtained a damaged certificate from the driver, and a Regd. notice has been served to the transporler claiming a monitory compensation. The vehicle was photographed after repairs/replacements showing the damaged parts also.Details of the damaged vehicleMake TATAIndica.Xeta GLS.Chassis No. 600731 BQZP13963.Engine No. 475S158BQZP16201.Speedo Meter Reading 8.1 Kms.Reference to policy Since the detailed policy was not made available therefore no comments on the same G,ln be made. Re.~idence: 92, <"as Vik:" Colony, Behind Bareilly Club, Bareilly - 243001 Office: Anand Ashram Complex, Rampur Garden, Bar-eilly - 243001 (1St Dr V K Chawla) Mobile: 98370 - 53743 Office: 058]-2453248 Resi: 058]-2428505
  16. 16. A. K. MATHUR Insurance Surveyor SLA-5521 Valid upto 26-Q2.2012 SURVEY FEE BLL 05.05.09.To,The Divisional Manager,The New India Assurance Co. Ltd.,lJivisiona! Office,Pune. Ref-Transit claim invoice no. 9011088626 dated 21.03.09 M/s TATA Motors Ltd. Pune, to M1s Grover Trade Links (P) Ltd., Bare illy. (D.P.) ____________ ~~ ~ __ w __ ~ -~-------------------- Survey fee Rs.1500.00 Rs. 200.00 Conveyance Local Photographs 6 nos. Rs. 90.00 Re-inspection photographs 2 nos: Rs. 30.00 Local Conveyance Rs. 200.00 Total Rs.2020.00 Residl!!!ce: 92, 1V3S Vikas Colouy, . Officc: Amllld Ashram Complex, Rampn! Gardc!!, Barcilly 243001 (Is, D" V K Chawla) Mobile: 98370 53743 Office: 0581-2453248 Rcsi: 0581-2428505
  17. 17. Damage certificate to be issued on the letter head of the transporterTo:Name of the dealerAddressSub: Dama2:e certificate without prejudiceDear Sir.This is with reference to your monetary notice Ref. No dated received by us.We do hereby certify purely as witness, that the consignment booked under our GCNote/RR/LR No dated from to (name of the dealer and location)at owners risk, subject to the terms and conditions of our carriage has been delivered onedate) to the consignee ..( name of the dealer and the location of the dealership) andfollowing vehicles got damaged while transit through our car carrier/trailor No ....Sf. No . description Amount Yehicle Model Damage no. Claim ChassisThe goods were transported by us at owners risk basis. This certificate of facts is issuedat the specific request of the consignee, solely for the purpose of lodging of theirinsurance claim if any with their risk and is without admission of any liabilitiesnegligence or defaults on our part in regard to anyloss/damage/destruction/leakage/deterioration in transit.This is strictly without prejudice.Name of the TransporterAuthorized signatory
  18. 18. ---------------~~------ - --- - --- - SEW KISHOR TRANSPORT SERViCES PVT. LTDe DAMAGE CERTIFICATE WITHOUT PREJUDICE Ref.No. KTSPljDMGTK/09-10/13 Date 18.05.2009 To, CONCORDE MOTORS, COCHIN Dear Sir/Madam1 This is with reference to your monetary notice No. NIL dated 13.04.09 received by us. We do hereby certify purely as witness1 that the consignment booked under LR 12466 dt 16.03.09 from Pimpri (Pune) to CONCORDE MOTORS, COCHIN at owners risk, subject to the terms and conditions of our carriage has been delivered to the consignee or to their order and following vehicles got damaged while transit through our car carrier MH18M8678 I BODY SHELL DAMAGE , , LINEA MCA1107170 Claim Sr. Vehicle Chassis no 701151.88 I Damage Description 9003697CQZ Amount11 I The goods were transported by us at owner1s risk basis. This certificate of facts is issued at the specific request of the consignee1 solely for the purpose of lodging of their insurance claim if any with their risk and is without admission of any liabilities negligence or defaults on our part in regard to any loss/damage/destruction/leakage/deterioration in transit. T . trictly without prejudice. ....•• ll~~. -, tl J-~ S , ~ ransport Services Pvt. ltd ~tb~r~ignatory : ..•. Q Corp"taW Offi(e; 3, ijinkya Mansion is! floor, Near Hila, tiya /il1ya Shavan, 32, P.ndita Hamabai Road,MumbaHOO 007.Tel.: 2368 Ion • fax: 2368 0636. ·mail. 9 .kklMYilhoo.-: om Admn.Offic,,; D 10~. ne Induwial Areo, MiOC, Near london Pilmer. New!, Navi Mumbai· 400 706. Te/.: 2767 0004 i 05. Fax: 2767 0006. Email :kt,plmlJmbai@rediffma,L.-o.n 3riJuch Office-: n/74, !st Floor. C ·Nlng. POOrf{1 N-dgarCommercia: (ornp1,~x, (hikall RO{jd,M.LO,C.ChiJ)chwud ·4 j 019.1el.: 2/493.234 1) Fin(:2749 3~34 0 (-rTtJ:! kj~ho!pune(~vsnl.lie:.
  19. 19. --------------------------------------, ... -------- -."•.. Passenger Cor Dealer RETAIL INVOICE Ms. GROVER -TRADE LINK Invoice No : Grover-PB-R-0910-00101 GROVER TRADE LINKS PVT LTD Invoice Date: 07/04/2009 4TH KM, RAMPUR ROAD Model : Indica Xeta GLS C.B GAr-n, OPP. MINI BYE PASS Chassis No : 600731BQZP 13963 BAREILL Y Kms. :8 BAREILLY 243502 Vehicle Regn. No : AF Uttar Pradesh India Job Card No. : JC-Grover-PB-0809-006034 Customer TLN No : Job Card Date: 27/03/2009 NC Code; l-GHV5VL Service Request Type: Accident Customer P.O. No - Date: Payment Method: CREDIT U.P.T.TNO ;-BE-0106585 dt. 0110512006 C.S.T. No :- BE-5050795 dt 15/05/2006 TIN No. : 09907601894 SERVICE TAX NO ;- AACCG 3066DSTOOI Type UoM ~~ Part No/Job Code Particulars Qty Rate(Rs) D~si~ Di5. % VAT % VAT (Rs) Amouat(Ri I MJ (FR.LHS,SUNSET(PARTNOT PAID AVAILABLE) ) MI ( FR. BUMPER OIF ) PAID 200.00 MI ( FR.BUMPER PAINTING) PAID 3,060.00 @ 10 % Service Tax : 326.00 @2 % Education Cess: 6.52 @I % S&HE Cess: 3.26 Final Parts Inoice Amount: • 0.00 Final Labour Invoice Amount: 3,595.78 ------- -.... - ---- .. ---.----- ---- .•......• --------------------- .•. Gross Amount; 3,595.78 Parts Net Taxable Amount: 0,00 Adjustments: 0.22 Rupees Three Thou~andFi"c Hundred Ninet) Six Only. Grand Total; 3,5%.00 Terms and Conditions: E.&O.E. I) Goods once sold will not he taken ba<:k. 2) Only the courts of BAREILLY shall have jurisdiction in any proceedings relating to this contmct. 3 I/IVO hereby certify that my/our Registration Certificate under the VXI Act is in force on the date on which the sale of the goods specified in this bill I cash memorandum is made by melw and that the transaction of sale cavern! by this bill! cash memomndum has been effected by me/us in the regular course of my! our business, VelricIeI Goods received in good condition and to our satisfaction.. For GROVER TRADE LINKS PVT LID Customers Signature AutiiOrlsedSigruuory Prepared By : MUZAMMIL KHAN Date: 07/04/2009 .. _.a __ __ _ .. _ .. _ .. __ _ .. _ _ _ _ _ _ __ ....•....... GROVER TRADE LINKS PVT LTD • GATE PASS • Customer Name GROVER -TRADE UNK Invoice Ref. :Grover-PB-R-0910-OOtOl dated 07/0412009 Account Name: GROVER TRADE LINKS PVT LTD Invoice Amount: Rs. 3,596.00 Vehicle No : AF Job Card / Order ref JC-Grover-PB-0809-006034 dated 27/03/2009 Chassis No: 60073IBQZPI3963 Gate Pass No & Date: Model Name: Indic<t Xeta GLS Vehicle f Goods received, in good condition and to our satisfaction .. ~:)- Customers Signature For GROVER TRADE LINKS PVT LID 4th Km. Rarnpur Road, C. B. Ganj, Bareilly - 243 502 (UP) Tel:2560667,2560777,2561565,9927500115 e-mail:groverbly@gmail.com
  20. 20. (This claim form should be on a plain sheet and as per details below) THE NEW INDIA ASSURANCE COMPANY LIMITED MARINE CLAIM FORMFor dispatch of passenger vehicles from the factory premises ofM/s Tata MotorsLimited, Pimpri, Pune.Name and address of the ConsigneesG.C.Note/RRlLR No. and datePlace of destinationDate of receipt of consignment atfinal destinationReasons for delay in delivery, if anyDate on which loss or damage noticedNature/quantum ofloss As per nos. of estimate attached(attach separate detailed estimate) Damaged vehicles totaling Rs. _Has claim been lodged on CarrierIf not give reasons for itWas damage certificate obtained fromCarrier? If not, give reasonRemarks, if anyWe, the above named, do hereby, to best of our knowledge and belief, warrant the truthof the foregoing statements in every respect.Date: Signature of Claimant Name Designation Name of Dealership
  21. 21. The New India Assurance Co. Marine Claim FormFor dispatch of passenger vehicles from the factory premises of MIs Tata Motorsltd., Pimpri, pune :Conconle motors (India) ltdName and Address of consignees #l0,256Ic,Survey no. 1562/1nettor nHlnUtI fHlnchuyath, Coeh in,ernalmlamdist riet j,crala-(,82304 I 12466. 16.03.2009 1 GC Note I LR No. and Date Cochin 2. Place of Destination : 06/04/2009 3. Date of receipt of consignment at final destination :Due accident - FIR 110-0036) 5. Reasons for delay in delivery if any :06/04/2009 6. Date on which loss or damage noticed : As per _i_nos. of estimate 7. Nature/Quantum of loss attached, one per car (attach separate detailed estimate) Damaged vehicles totaling Rs ..101J.§1·88 : yes 8. Has claim been lodged on Carrier? If not, give reasons for it :Yes 9. Was damage certificate obtained from Carrier? If not, give reason :Body SheH Damage (Total Loss) 10. Remarks if any We, the above named, do hereby, to best of our knowledge and belief, warrant the truth of the foregoing statements in every respect. Signature of Claimant Date: 20/05/2009 For con~ Motors (India)Ltd Karuppasamy Business Unit Head cochin
  22. 22. LETTER FOR TOTAL LOS~ Date:20/0512009To,The Divisional ManagerNew India Assurance Co. Ltd.MumbaiSub: Body Shell Damage (Total Loss)Dear Sir,With respect to the below mentioned Chassis No., please note that the vehicle isbeyond repairs as the body shells of this vehicle is damaged. As a result thiscannot be sold as brand new vehicle. In view of this fact, please treat the vehicleas Total loss. Name of the Dealer: Concorde Motors (India) Ltd Name of the Transporter: Kishore Transport Services Pvt. Ltd. SDM NO. KTSPUDMGTK/09~10/13 Chassis No:- MCA11071709003697CQZ Thanking You, Yours W~eIY, Motors For co~i[o;de India Ltd Mr. Karuppasamy Business Unit Head Cochin
  23. 23. Format of letter of subroqation Letter of Subrogation & Special Power of Attorney N.S. Please Affix Adhesive Stamp of Rs.200/- here before Signing this documentTHE NEW INDIA ASSURANCE CO. LTD.DO: 121400, New India Centre,17/A, Cooperage Road,Mumbai - 400 039 In consideration of your having paid to us through Tata Motors Ltd., theconsignor, the sum of Rupees ./-Rupees only in full settlement ofour claim for non-delivery / shortage I damage and theft under Policy No..................................... issued by you all on the under mentioned goods, wehereby assign, transfer and abandon to you all our rights and remedies againstthe Railway Administration I Road Transport Carriers or other personswhatsoever, caused or arising by reason of the said damage or loss and grantyou full power to take and use all lawful ways means in your own name andotherwise at your risk and expense to recover the claim for the said damage orloss and we hereby subrogate to you the same rights as we have inconsequence of or arising from the loss or damage. WHEREAS, the consignor, Mis Tata Motors Ltd. booked the goods underInvoice nos dated Lorry Receipt. .dated from Pune to in our name, we hereby appoint, inominate constitute THE NEW INDIA ASSURANCE CO. LTD., carrying on iinsurance business, to act by their officer MR. DINESH A. PAl, Sr D.M. and his isuccessors as our true and lawful attorneys to do all or any of the following acts, Ideeds and things for us and on our behalf in our name that it to say: - I I 1. To receive claim moneys from the Carriers/Motor Transport I Company or Authorities payable to us under the aforesaid Invoice/Lorry Receipt. I 2. To give valid discharge on our behalf pertaining to the above claim.
  24. 24. 3. To sign all receipts in our name on our behalf pertaining to the above claim.4. To present any applications before any Authority or persons concerned for claim in respect of aforesaid Invoice/L.R5. To settle and adjust the above claim, if necessary and to give valid discharge and effectual receipts.6. To file suit in court of law against Carrier/Motor Transport Company, if necessary, for the recovery of the claim money for the aforesaid claim on our behalf and in our name and give valid discharge and effectual receipt thereto.7. To sign, declare, verify and present to courts, such plaints, affidavit and applications in connection with claim recovery suit filed against carriers/Motor Transport Company. We. the said firm , do herebyratify and confirm and agree to ratify and confirm all the acts and thingswhich our said Attorneys shall lawfully do or cause in the done pursuant inthese presents. IN WITNESS WHEREOF IMR (designation) Authorised Signatory of the Firm ofM/s for and on behalf of the Firm have set my hand andSeal aL this day of .SIGNED SEALED AND DELIVEREDby the within named firm ofM/s.through the hand of MR (name and designation)Signature of Consignee BEFORE ME NOTARY

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