Mechanical Statement Report/ Physical Damage Inspection
Client Name
Contact
Email Address
Date
Time
Hours
-
12
01
02
03
04
05
06
07
08
09
10
11
Minutes
-
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Named Insured
Policy No.
Car Make
Chasis Number
FOR PHYSICAL DAMAGE COVERAGE, conduct a visual inspection of the vehicle and indicate on the illustration the areas where any damage exists, such as dents, holes, chips, scratches, rust, etc. Give special attention to bumpers, windshields and condition of paint. Describe any present damage in the space provided below.
Front Image of the car/vehicle/automobile
Drag and Drop (or)
Choose Files
Left Image of the car/vehicle/automobile
Drag and Drop (or)
Choose Files
Rear Image of the car/vehicle/automobile
Drag and Drop (or)
Choose Files
Right Image of the car/vehicle/automobile
Drag and Drop (or)
Choose Files
Interior Image of the car/vehicle/automobile
Drag and Drop (or)
Choose Files
Image of the engine of the car/vehicle/automobile
Drag and Drop (or)
Choose Files
Any other information necessary.
Submit details
Save as Draft
Please do not fill in this field.
Open chat
Powered by
Joinchat
Hello theređź‘‹,
how can we help you today?
Call us