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Case Ref No- DEC/30

Protocol - Preliminary Inspection format / Joint Inspection Note

Basic Details

Name of Insured M/S BEST FOODS LIMITED

Address of InsuredPLOT NO-11, OPP, GRAIN MKT

O/S BHAGTAN WALA, AMRITSAR

Location of Loss SHERON ROAD, TARN TARAN, DISTT TARN TARAN

Date of Loss

08/12/11 TO09/12/11

DURING NIGHT

Date of Survey 09-12-11

Policy No.

2430/51734322/00/000

Sum Insured TOTAL SUMINSURED

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Type of Loss Marine / Engineering / Miscellaneous / Fire

Sequence of Mishap TYPE OF LOSS-MARINE

As per the instruction received, I visited the premises ofthe loss & insureds tarn taran office and met with Mr Sonu Arora, Mr Davinder,truck driver Mr Dulip Mashi and truck owner Mr Sanjeev Kumar in order to inspectthe loss.

As discussed with truck driver, owner & insured they stated that they send theconsignment of total 546 Nos of paddy bags from Best Foods Limited {Arora

Trading Co} tarn taran to Best Food Ltd, H/O Jalalabad, Mathija Rice Mills, Jalalabad.

The consignment was sent on 08/12/2011 from Tarn Taran by Truck No-RJ-13-GA-0334 of Transporter M/S Azad Road Line, Near Bath Chowk, Tarn Taran, Vide GR NO-3308 dt 08/12/2011.

As discussed with the driver that at 11.30 PM t0 12.00 PM when he was passingfrom tarn taran, approximately after 3 KM at sheron road the truck was suddenlygot un balance and the front right wheel of the truck hit the road divider and felldown toward his left side. Some how the driver & cleaner came out from the cabinand immediately inform the truck owner & insured.

As stated by the driver that since they got minor injuries they went for thetreatment. In their absence some un known mischievous person took away 35 bagsof paddy. Since the truck over turned the diesel started leaking from the diesel tankwhich also partially damage the 19 bags of the paddy.

Inspection- On inspection it was found the consignment truck was over turned duewhich 19 bags of paddy were partially 50% damage due leakage of the diesel andon counting the total bags 35 paddy bags were missing and the photographs werearranged accordingly.

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Case Ref No- DEC/30

Marine

Invoice No.3609 DT08/12/2011

GR No.3308 DT08/12/2011

TARN TARAN TO

JALALABAD- 3308

Consignor

M/S BEST FOODLTD, TARN TARAN,DISTT TARN TARAN

Consignee M/S BEST FOODLTD, H/O

JALALABAD,MATHIJA RICE,MILL.

ConsignmentDetails

TOTAL 546 BAGS OF PADDY HAVING WEIGHT 50 KG EACH.

TOTAL WIGHT OF 546 BAGS 273 QTLS.

Packing DetailsPADDY MATERIAL WHICH IS USED AS RAW MATERIAL INSHELLERS, PACKED IN THE JUTE BAGS. ON THIS BAG NAME OF

THE BRAND BEST IS PRINTED.

Salvage Details50% PARTIALLY DAMAGE PADDY BAGS

Further course ofaction

Engineering / Breakdown

Name ofItem/Machine

Sr.No.

Make Model

Capacity MFG. Year

Comments ofRepairer

Amount ofEstimate preparedby Repairer

Further Course of

action

Repairer contactDetails

Cause of Loss (Asper Insured)

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Cause of Loss (Asper Adjuster)

Case Ref No- DEC/30

Fire / Theft

Affected Items

COLOUR TV-14

AIRCONDITIONER,MAKE-L.G, 1.5 TON,{GRILL ONLY}

MCB, SWITCH

CURTAINS, ROD

DOUBLE BED

TABLE

BED SHEEETS

MATTRESS{COTTEN}

MIXER, LOCAL

CEILING, WALL