Machinery Breakdown survey report format

Surveyor Ref:		Date:
MACHINERY BREAK DOWN – SURVEY REPORT               (This report is issued with out prejudice in respect of cause nature and extent of loss / damage and subject to the terms and conditions of the Insurance policy.)

INSURANCE POLICY PARTICULARS	Name of the insurer	:
	Name of the insured	:
	Policy number	:
	Period of insurance	:
	Type of policy	:	Machinery break down
	Premises / works address	:
	Item insured as per policy	:
	Total sum insured	:
	Total premium charged	:
	Failed item covered in policy	:	Schedule serial number :
	Sum insured for failed machine	:
	Initial policy excess	:

BREAK DOWN DETAILS	Date of break down	:
	Time of break down	:
	Witness of the occurrence	:
	Place of occurrence	:
	Repair work attended by	:
	Amount claimed by the insured	:

SURVEY PARTICULARS	Survey work appointed by	:
	Date of appointment	:
	Date of survey	:
	Place of survey	:
	Person present during survey	:

DETAILS OF FAILED UNIT	Purchase invoice particulars	:
	Details of guarantee period	:
	Function of the machine	:
	Details of log book	:
	Name plate details	:
	Details of damage	:

INSURABLE  INTREST

On verification of records produced by the insured, I came to know that the said failed Machine was owned by the insured and hence the insured has insurable interest in the here mentioned machine.

                                   

ADEQUACY OF SUM INSURED	Insured value of the machine failed machine	:	Rs.
	Present cost of the new machine	:	Rs.
	New machine quotation received from	:	M/s.
	Remarks	:

           

ABOUT THE RISK
	It was informed that there was no major loss / damage in the past.
	The said machine is operated and maintained as per the recommendation of OE manufacture.

CAUSE OF LOSS

LOSS ASSESSMENT	The sudden, unforeseen physical loss / damage to the insured property had occurred during the period of insurance and due to a peril not excluded in the policy. There is no breach of warranty nor willful act / negligence on the part of insured. Hence, in my opinion the claim is admissible. I have given below my assessment.
	SL No	Particulars	Qty	Estimate	Assessed

SURVEYOR COMMENTS	Serial number of the failed machine was verified physically and found in order with policy copy.
	The sum insured for the damaged property is adequate / Not adequate
	Depreciation :
	Salvage value :
	In my opinion amount payable to the insured is Rs. ………………..
	I have received the claim papers from the insured on …………………
	The repaired unit was inspected by me on ………………… . Copy of invoice and payment details were collected and enclosed for your reference.

SIGNATURE

.

ENCLOSURES	Survey bill	Photos taken by me        Nos.
	Claim intimation letter	Claim form
	Estimate	Policy copy
	Witness statement	New machine quotation–to check adequacy of insurance
	Final bill with payment details	Test report after completion of repair work.

Valuation Report Format

Surveyor Ref:					Date:
MOTOR VEHICLE – VALUATION REPORT (This report is issued with out prejudice and with out any commitments )

REGISTRATION				PERMIT
Name of the RC owner	:			Permit holder name	:
Registration number	:			Type of permit	:
Make / classification	:			Permit number	:
Date of registration	:			Validity of permit	:
Chassis frame number	:			Area authorized	:
Engine serial number	:			INSURANCE POLICY
Class of vehicle	:			Insured with	:
Fuel used	:			Insured name	:
Road tax paid up to	:			Policy number	:
Fitness cert. Validity	:			Period of insurance	:
Hypothecated with	:			Insured value	:

INSPECTION / CONDITION OF VEHICLE
Work entrusted by	:
Date of intimation for Assignment	:
Date and time of inspection	:
Place of inspection	:
Mileage reading during inspection	:
Person present during survey	:
Condition of vehicle	:
Accessories / extra fitting parts	:

SURVEYOR COMMENTS

It appears that the vehicle has been maintained well.

Engine serial number, Chassis frame serial numbers were verified physically.

Registration certificate, insurance policy particulars were not produced for my verification.

Present market value of the vehicle is Rs.

VEHICLE PHOTO – FROM FRONT SIDE		VEHICLE PHOTO – FROM REAR SIDE

CHASSIS No. TRACE
XXXXXXXXXXXXX                                                                                                                                                                            Assessor.