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Satisfactory Voucher

The document contains forms and vouchers from HDFC ERGO General Insurance Company related to processing motor vehicle insurance claims. The forms acknowledge receipt of payment for vehicle repairs, provide options for direct deposit of claim amounts, and include sections for signatures from insureds, repair shops, and financiers involved in claims. Information on the forms includes claim numbers, vehicle details, payment amounts and dates of loss or repairs.

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vrevatienterprises
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8K views

Satisfactory Voucher

The document contains forms and vouchers from HDFC ERGO General Insurance Company related to processing motor vehicle insurance claims. The forms acknowledge receipt of payment for vehicle repairs, provide options for direct deposit of claim amounts, and include sections for signatures from insureds, repair shops, and financiers involved in claims. Information on the forms includes claim numbers, vehicle details, payment amounts and dates of loss or repairs.

Uploaded by

vrevatienterprises
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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HDFC ERGO General Insurance Company Limited

(To be obtained from the insured, where payment is being made directly to the repairer.) Motor Claim No. I/We hereby acknowledge having received from Motor Vehicle No.

Satisfactory Voucher

(name of repairer/garage) my/our Motor Car/Vehicle/Motorcycle No.


payment of Rs. company under policy no. Place: Address:

which has been repaired to my/our satisfaction, and I/We admit that the

on account of such repairs by HDFC ERGO General Insurance Company Limited is in full discharge of my/our claim upon the said in respect of the damage caused to the said Motor Car/ Vehicle/Motorcycle in an accident that occurred on _____/_____/______ Date: Signature of the Insured (Please affix office Rubber Stamp for company-owned vehicle)

6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri (East), Mumbai 400 059. Toll Free No. 1800-2-700-700 Fax: 91 22 6638 3699 [email protected] www.hdfcergo.com

HDFC ERGO General Insurance Company Limited

(To be obtained from the insured or the Repairer to whom payment is made) Motor Claim No. Do you want us to deposit the claim payable amount directly to your bank a/c If Yes. Bank Name Yes A/C Number Signature of A/C Holder: No Policy No.

Motor Loss Voucher

A/C Holder Name

Received from HDFC ERGO General Insurance Company Limited the sum of Rupees. in full and final settlement of our bills and cash memos for accident repairs to and/or theft of Vehicle No. for loss suffered on ___/___/_____ Rs. (In figures) (Insureds Name and Signature) Place Date please affix Revenue stamp if the amount exceeds Rs.500/-

6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri (East), Mumbai 400 059. Toll Free No. 1800-2-700-700 Fax: 91 22 6638 3699 [email protected] www.hdfcergo.com

HDFC ERGO General Insurance Company Limited

(to be obtained from Bank, Financier or lessee where the vehicle is under Hypothecation or Hire Purchase) Received this day of 20 from HDFC ERGO General Insurance Company Limited the sum of Rupees (in words) which I/we agree to accept in full satisfaction and discharge of all claims present or future under Policy No. Vehicle No. which occurred on ___/___/20____ Rs.(in figures) in respect of please affix Revenue stamp if the amount exceeds Rs.500/-

Motor Loss Voucher

(No Objection Note where the Financier wants the claim to be paid directly to the vehicle Owner) I/We hereby authorise the Insurance Company that the amount stated above may be paid to the hirer. Signature of Duly Constituted Authority Address of Claimant (Name of Financier/Bank/Company)

6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri (East), Mumbai 400 059. Toll Free No. 1800-2-700-700 Fax: 91 22 6638 3699 [email protected] www.hdfcergo.com Registered Office : Ramon House, H.T. Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020.

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