Page 31 - The Insurance Times June 2020

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LOCATION OF THE
AFFECTED PREMISES
OCCUPATION
TIME, DAY & DATE OF LOSS
TIME & DATE OF INSTRUCTION
FOR SURVEY
TIME & DATE OF SURVEY
PERSON(S) a.
CONTACTED, WITH b.
DESIGNATION AND c.
CONTACT DETAILS
CAUSE OF LOSS
NATURE & EXTENT OF -------------
DAMAGE / LOSS Photographs of major damage taken during survey enclosed
(Enclosure 2).
INSURED'S CLAIM Loss estimated: Rs……. (Enclosure 3) (Optional)
PROVISIONAL / INTERIM Minimum Liability on Indemnity/Market Value basis: Rs…...
ESTIMATE OF LOSS Maximum Liability on RIV basis: Rs.
Refer Provisional loss assessment worksheet attached, based
on Insured's estimate.
REMARKS 1. The Insured have been provided with a detailed list of requirements
of documents and information.
2. A detailed assessment of loss based on further verification, testing,
validation and evaluation will be carried out and covered in the final
survey report (FSR).
3. The FSR will provide final loss adjustment and reckon with all
applicable adjustments, salvage, evaluation of value at risk and
application of under-insurance, if any, and policy excess.

INSURER'S LIABILITY:
The reported loss falls within the ambit of the Policy. The Minimum Liability on Market Value basis has been provisionally
assessed at Rs…..., and the Maximum Liability on RIV basis at Rs.............
The Insurer can make an interim / on-account payment of Rs… at this stage to provide an interim relief to the Insured,
and we confirm that this amount will not be more than the Minimum Liability on Market Value basis under the policy.
The survey has been conducted and this Interim Survey Report is issued without prejudice and is subject to the terms
and conditions of the policy of insurance.
Enclosures:
1. Copy of Policy Schedule
2. Photographs of major damage taken during the survey
3. Insured's estimate of loss dt………..
4. Copy of Surveyor's mail dt…. to the Insured giving list of requirements

NAME & SIGNATURE OF INSURANCE SURVEYORS & LOSS ASSESSORS

The Insurance Times, June 2020 31