Motor Vehicle Accident Report Form 汽车意外报告书.PDF

Motor Vehicle Accident Report Form For Official Use Only Claim No. 汽車意外報告書 (I) Insured 保戶 Name Occupation 姓名 職業 Policy / Certificate No. Period of Insurance 保險單號碼 承保日期 由 Residential Address Tel. 住宅地址 電話 Office Address Tel. 辦事處地址 電話 (II) Insured Vehicle 承保車輛 Registration Marks. Make 車牌號碼 廠名 Model Year of Manufacture 款式 製造年份 Engine No. Chassis No. Date of Purchase 引擎號碼 車身底盤號碼 購入日期 Hire Purchase Owner No. of passengers being carried at the time of the accident excluding driver 所屬財務公司 意外時所載乘客人數 (不包括司機) Nature of goods being carried at the time of the accident 意外時所載貨物種類 (III) Driver 駕駛人 Name Date of Birth Occupation 姓名 出生日期 職業 Residential Address Tel. 住宅地址 電話 Office Address Tel. 辦事處地址 電話 I. D. Card No. Driving Licence No. 身份證號碼