Reference No.
Application No.
Valuation Initiated By*
Financer's Representative*
Place Of
Valuation*
Registration
Number*
Report
Date*
Make And Model*
Inspection Date*
Chassis Number*
Registration Date*
Engine Number*
Colour*
Registered Owner*
Seating Capacity*
Finance Taken By*
Regd. Laden Wt.(Kg) *
Fuel Used*
Regd. Unladen Wt.(Kg)*
Owner Serial Number*
Cubic Capacity*
Tax Paid Upto
MM Reading(Kms/Hrs)*
Hypothecation*
Battery*
Policy No.
Radiator*
Validity
AC*
Policy Type
Power Steering*
Owner in Policy
Power Window*
Sum Insured(IDV)
Air Bag*
Right Side Tyres
Left Side Tyres
General Comment
Extra Data (Record Only)
Fair Amount*
Declaration*
Staff Name
Total Amount*
Amount Received*
Remaining Amount
Deposit Amount
Depositor's Name and Date
Balance Amount
Chassis Impression Photo
Photo
Stamp Show