Insurance Claims Application Report Example
How to write an application report? This is the first time to write a request report of the relatives of the most want to know the thing. Do not know how to write a request report is okay, the following is my compilation of insurance claims application report sample, welcome to read and learn.
Insurance Claims Application Report Example 1
Applicant: XXXX Company Limited
Residence:
Respondent: China XXXX Insurance Company Limited
Residence:
Requests:
1, Respondent to the applicant to pay the vehicle damage insurance premium of 209,509.13 yuan.
2, the respondent to pay the applicant's indirect losses of 72,000 yuan.
Facts and reasons:
May 13, 2014, the applicant on the company's concrete pump truck (the use of nature: other non-business vehicles) to the respondent company insured motor vehicle traffic accident liability compulsory insurance policy and loss insurance. The insurance policy numbers are:PDZA2014XX047245 and PDAA20XX0612.The underwriting types are motor vehicle damage insurance, third party liability insurance, vehicle occupant liability insurance (driver (D11)) lifting, loading and unloading, excavating vehicle damage extension clause (K1) special vehicle fixtures, apparatus damage extension clause (K2), deductible coverage A/B/D11 ...The periods of insurance are all from 0000 hours on XXX, 2014 to 2400 hours on XXX, 2015.
At 23:11 on October 06, 2014, the applicant's driver X drove the heavy special purpose vehicle of Gan XXX, traveling from XXX town to XX village, driving to the place of the incident, crashed into a stone pier next to the road, resulting in damage to the vehicle of the . Traffic accident. After XXX traffic management brigade road traffic accident certificate (summary procedure), the applicant company's driver XXX bear full responsibility for the accident.
At the time of the incident, the applicant company's responsible person has been contacting the respondent company, but the respondent company has been using a variety of excuses to shirk come to the scene of the accident, after the applicant company had no choice but to complain about the staff of the respondent company, two hours later, only one after another to come to two staff members, the staff arrived at the scene with a rather bad attitude, that is, do not actively understand the situation at the scene, and do not actively request the applicant The company produced relevant materials. He dropped a sentence: your company's vehicle is a traffic accident caused by spontaneous combustion, the insurance company does not bear any compensation? I'm not sure if I'm going to be able to do that.
2014 XX month XX by Jiangxi XXX service center fault detection analysis report, Gan XXXX concrete pump truck failure phenomenon phenomenon is a line short circuit caused by the right side of the cab burned seriously, the cause of the failure analysis: due to the left side of the central bumper collision fracture, resulting in the upper mounted wiring harness pulling fracture, caused by a short-circuit combustion. Solution: replace and repair the burnt wiring harness and module, etc., repair cost ***209509.13 yuan. According to the motor vehicle damage insurance provisions of the insurance liability, that is, in line with the insured's permission of the driver in the use of the insurance vehicle in the process, due to fire, explosion and other causes, resulting in the loss of the insured vehicle, the insurer is responsible for compensation. Applicant company driver XXX driving license permit type is B2, in line with the insured's permission of the driver.
XX City Ready-Mixed Concrete Association price list clearly indicates that the concrete pump truck one day operation price is 3000 yuan. On October 16, the date of the accident to date Gan XXXX has been out of service for 24 days, so the applicant company should be liable for the loss caused by the applicant company's failure to perform the contract at the agreed time, *** 72,000 yuan.
The Respondent Company shall be liable for the Applicant's payment of 209,509.13 RMB for the insurance premium for the loss of the vehicle, and the Respondent shall pay the Applicant's consequential damages of 72,000 RMB, **** RMB 281,509.13 RMB.
Applicant: XX Limited
20** XX month XX
Insurance Claims Application Report Sample 2
XX Insurance Company:
My name is XXX, age X years old, where the school XXXX. 20XX XXX X X, X time, in the school on the physical education class. During the physical education class at school, I was sent to hospital for treatment of an injury to my arm caused by playing ball, which has now been healed. In the hospital during the cost of medical expenses XXX yuan, because I handle your insurance, (insurance policy number XXXX, insurance name XXXX,) the special claims application, hope to be accepted to handle.
Application matters: request the People's Insurance Company of China Guangzhou Baiyun Branch in accordance with the agreement of the motor vehicle insurance policy to the applicant to pay the vehicle damage insurance and third party liability insurance. Facts and reasons:
At 18:10 on January 29, 2001, the applicant Zhu Xiaowei driving Guangdong A4K473 minibus along the 107 line from north to south, traveling to the 107 line 2289KM + 800M, touching and scraping the same way driving by the right main lane to the middle of the main lane from the main lane by the Liang Torch Qing driving the Guangdong AA9636 truck, which then caused vehicle and flower base damage, the big truck on the and flower base damage, the occupants of the truck Liang Ruhong, Liang Jinhua injured in a traffic accident. Qingyuan city public security bureau traffic police detachment to make responsibility: First, the applicant Zhu Xiaowei driving speeding, his behavior violates the "Chinese people's *** and country road traffic management regulations" article 35 (1), is the main cause of the accident, the main responsibility for the accident. Second, Liang Zhaoqing driving lane change without paying attention to safety and give way, his behavior violates the "Chinese people's *** and the State Road Traffic Management Regulations" Article 7 (1), is the secondary cause of the accident, is responsible for the accident of secondary responsibility. Third, the rider Liang Ruhong, Liang Jinhua is not responsible for the accident. After the incident, the applicant to the Qingyuan City Public Security Bureau Traffic Police detachment to re-determine the responsibility of the application, the Qingyuan City Public Security Bureau Traffic Police detachment maintained the results of the first determination. The applicant incurred nearly 90,000 yuan in accident repair costs and other related expenses, and advanced 120,000 yuan in medical expenses for the injured.
Your staff also emphasized that only one claim will be processed for multiple claims under one policy for one traffic accident, and that multiple claims will be processed together.
The injured Liang Ruhong, Liang Jinhua until October 2007 to the Guangzhou Baiyun District People's Court filed a civil lawsuit, the court ruled that the applicant Liang Ruhong 285726 yuan, and the total amount of 419,608 yuan jointly and severally liable; Liang Jinhua 8,498 yuan, and the total amount of 12,127 yuan jointly and severally liable. Subsequently, the applicant filed an appeal to the Guangzhou Intermediate People's Court, the Guangzhou Intermediate People's Court made the following judgment on February 13, 2009, the applicant assumed Liang Ruhong 254,212 yuan, and the total amount of 374,588 yuan jointly and severally liable; assumed Liang Jinhua 8,128 yuan, and the total amount of 11,611 yuan jointly and severally liable.
During the litigation period, the applicant also went to your company's place of business in Dezheng Road, your staff again told the applicant to wait for the case to be finalized and then on the vehicle damage and third-party liability insurance claims.
People's Insurance Company of China, Guangzhou Baiyun Branch
The applicant:
;
The applicant is a member of the China National Insurance Company, Guangzhou Baiyun Branch.