(LETTER OF INTIMATION TO BE ADDRESSED TO CORPINS AND P&M, HO FOR SURVEY)

CLAIM INTIMATION - ACCIDENTAL DAMAGE TO EXCAVATOR

We wish to report a claim as under: Detailed name of damaged item . 1. SAP reference

2. Make CATERPILLAR 3. Model 320D-2 4. Year of manufacture 2014 5. Time and date of loss

6. Probable cause of loss Accidental sliding of rock boulder over excavator

7. Statement of the person who witnessed the loss first

Will be sent tomorrow

8. Statement of his manager Will be sent tomorrow 9. Details of damage Counter weight, fuel filter assembly, chassis ,

sheet metal parts, Hydraulic gauge assembly 10. Estimate of loss Rs.20,0000 (Approx) 11. Photographs of loss Attached 12. FIR, if any N/A

Please advise us on appointment of surveyor and his contact details. The surveyor may contact the undersigned for coordination.

XXXXXXXX Name: -

Encl as above

From To Corporate Insurance Deptt, (CORPINS)