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Satisfaction Uiic

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shailja.intl
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5K views1 page

Satisfaction Uiic

Uploaded by

shailja.intl
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CLAIM DISCHARGE /SATISFACTION VOUCHER

TO

The United India Insurance Co. Ltd.

…………………………………………………….

…………………………………………………….

Dear Sir,

Policy No. …………………………………………………… Claim No. …………………………………………………………………………

Vehicle No. ………………................Chassis no…………………………… Engine no………………………………………………

My above mention vehicle has been repaired up to my complete satisfaction, Henceforth I am taking
delivery of the same and authorized to my insurer i.e. United India Insurance Company to make the payment
of Rs______________(Rupees _____________________________) Bill No…………….…Bill Date…………………………

to garage in respect of my above mention claim. I also conform having paid


Rs_____________(Rupees_______________________________________)in lieu of depreciation, policy
excess and any additional work carried out at the garage.

I/ we have accepted the payment towards full and final settlement of my claim & I am fully satisfied for
settlement of the claim.

I/ We hereby discharge United India Insurance Co. Ltd against any liability arising out in furtherance of this
claim.

………………………………. …………………

(Signature of Insured) (Stamp & Signature of Repairers)

Name :-

Address:

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