1- Accident Date Time City: District: District:
2- The Place of the Accident District: Street:
District: Street:
3-Eyewitnesses
Name Last Name Address Tel No:
A 8- Check the Appropriate Box (x) B
VEHICLE A Red light violation VEHICLE B
4- Driver Information Entering the highway where no vehicle is allowed to enter 4- Driver Information
Name Last Name: Entering the road used by traffic coming from the opposite direction Name Last Name:
TC Identification Number: Passing through a place where there is no passage (overtaking is not allowed) TC Identification Number:
Driver’s License No and Class: Failure to comply with the priority of crossing at the intersection Driver’s License No and Class:
Place of Reception (Province/District): Passing at the stop sign of the authorized officer.
Address: Address to the vehicle in front of you while driving in the same direction and in the same lane:
Being hit from behind
Tel No: Failure to comply with the rules of right turn Tel No:
5- Vehicle Information Does not comply with the left turn rules 5- Vehicle Information
Make and Model: Failure to comply with the reversing rules Make and Model:
License Plate: Failure to comply with passing (overtaking) rules License Plate:
Usage: Failure to comply with the priority of passing Usage:
6- Traffic Insurance Policy Information Failure to comply with parking rules 6- Traffic Insurance Policy Information
Name and Surname of the Insured Person: Failure to comply with the Rules of Stopping The Name and Surname of the Insured Person:
TC ID No: Entering a parked vehicle in accordance with the rules TC ID No:
Title of the Insurance Company: km/h Speed Status km/h Title of the Insurance Company:
Agent No:
m. Brake track length if detected
m. Agent No:
Policy No: Policy No:
TRAMER Document No: TRAMER Document No:
Policy Start-End Date: Policy Start-End Date:
7- The place where the car first hit. 7- The place where the car first hit
indicate with the arrow sign (→). with the arrow sign
(→) specify.
front front
back to back
9- Draw a sketch of the crash site and the moment.
10- Driver reviews 10- Driver reviews