7/31/2019 Vehicle Damage or Theft-Contract# 14496
1/2
Company Name ALD Contract No
Employee Name Date of Registration
Contact Number Door to Door Service
Vehicle Make / Model Registration No
Date of Accident Speed of Vehicle
Time of Accident
Present Kms
Driver Name(at the time of accident) Date of FIR
Valid Drivers Licence No FIR No. / Diary No.
Vehicle Authorised to Drive Address of Police Station
Issued by Valid Upto
Copy of Registration Certificate & Driving License must
accompany this report form.
Brief description of the accident justifying the damage on the
vehicle including third party damage. If any
(specify in detail and use additional sheet, if necessary)
Date :
Workshop Name Workshop Visit Date
Contact Person Suveryor Name
Mobile No Suveryor Contact No
Insurance Company Name Suvery Date
Policy Number Estimate Amount
Validity Peroid Estimate Amount Passed
PDLW Claim Eligble
RC Verified Estimate Delivery Date
DL Verified Actual Delivery Date
FIR (if Required) Payment Mode
Fax : Mumbai - 022 61933213 Delhi - 011 4661 3222 Bangalore -
080 4061 3248 Hyderabad - 040 2335 5990
Email : [email protected] Web:
www.aldautomotive.co.in
Yes / No
ALD / Dealer
ALD Road Side Assistance No :1800 - 102 - 8100alternate no. 0124
- 4278181
(Round the Clock)
ALD Toll Free No :1800 - 209 - 5253[Mon to Fri Time 0900 - 1730
hrs]
Yes / No
Yes / No
* Wherever FIR is mandatory, repairs will not commence unless
FIR details are provided. FIR details are mandatory
For Internal use Only
(Name & Signature)
ATTENTION* Damage to the vehicle that is not justified because
of the above accident will not be covered in the claim
* Fill separate forms for individual incidence of damage. Sign
& send to ALD within 48 hrs of occurance of the event.
E-Mail version of this form will not be accepted.
Driver Details FIR Details (if necessary)
Place of Accident
Damage / Theft Report Form
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]
7/31/2019 Vehicle Damage or Theft-Contract# 14496
2/2
INSURANCE & DAMAGE REPAIR SERVICES
You need to call on the Toll free number1800-209-5253 to book
your vehicle for any attention that it may need.
ALD shall arrange as per your contract for appropriate insurance
cover of the vehicle and its renewals and this would cover
any external damage to the vehicle based on the approval from
the insurance company.
In the unfortunate event of a damage or accident of the vehicle,
always check for safety of all occupants and then the vehicle
and take all precautionary measures to avoid additional damage
(check water and oil levels, etc). If the vehicle is safe to
drive,
take it to the nearest safe place and park. Report the matter
immediately to ALD. Damage Theft Form provided in the ALD
Service Guide be filled with care and sent to ALD. In the case
of theft, attempted theft or vandalism, lodge a complaint with
the police and send a copy of the First Information Report (FIR)
or receipt acknowledged copy of the statement given.
Upon receipt of the accident report, we appoint a surveyor for
inspection and assessment of repairs, only then the repairs on
the
vehicle can start. On consultation with the repairer and the
insurance company, ALD shall report the schedule of vehicle
repair
and its time for completion.
Theft or loss of key
Take extreme care to protect all sets of keys provided with the
vehicle. In the event of loss of key, you need to report it to
the
Police.
Note:Damaged vehicle when driven could result into additional
damage to the vehicle which is not covered under
insurance and hence will be rebilled. While handing over the
vehicle for repairs check it thoroughly and take out
all personal belongings, stereo panel.
The ALD Service Guide contains all of it and will be of
assistance to you and should you have any questions on it, we will
be
happy to discuss and clarify the same.
We at ALD would like to wish you safe driving and a happy
motoring experience
