REQUEST FOR WARDEN TRAFFIC ACCIDENT REPORT

Should you wish to print this form kindly REQUEST FOR WARDEN TRAFFIC ACCIDENT REPORT click here.

REQUEST FOR WARDEN TRAFFIC ACCIDENT REPORT TALBA GHAR-RAPPORT TAL-WARDEN DWAR INCIDENT STRADALI
You should request a Warden traffic accident report only if you suffered loss in this accident and have reasonable cause to obtain it.   We will use the details which you fill in this form to check that you are entitled to this report. All information will be treated in strict confidence. Ghandek titlob rapport tal-Warden dwar incident stradali  fil-kaz biss li inti sofrejt hsara f’dak l-incident, u ghandek raguni valida biex titolbu.  Bid-dettalji li timla, ser naraw li inti intitolat ghal dan ir-rapport. L-informazzjoni li taghtina tinzamm kunfidenzjali.
ACCIDENT DETAILS DETTALJI DWAR L-INCIDENT
Warden’s Traffic Accident report number Numru tar-rapport tal-incident stradali moghti mll-Warden
Accident date Data tal-incident
Place of accident Post tal-incident
Did you suffer material loss in this accident? IVA / LE Sofrejt hsara materjali f’dan l-incident?
Did you incur bodily injuries in this accident? IVA / LE Korrejt f’dan l-incident?
DETAILS OF VEHICLE A DETTALJI TAL-VETTURA B
Vehicle registration number Vehicle registration number
Make/model Make/model
Name and Surname of vehicle owner Name and Surname of vehicle owner
DETAILS OF THE APPLICANT DETTALJI TAL-APPLIKANT
Name and Surname Isem u Kunjom
Identity card number (copy attached) Numru tal-karta tal-identita (kopja ma’ din l-applikazzjoni)
Telephone number Numru tat-telefon
Email address Indirizz tal-email
Current address Indirizz kurrenti
Signature of applicant Firma tal-applikant
Additional information should be added at the back of this form.  The completed form together with (1) a copy of your identity card and (2) a cheque payment for €15, should be sent to:Malta Insurance Association
43A/4 St Paul’s Buildings,
West Street
Valletta
Informazzjoni addizzjonali ghandha tizdied fuq wara ta’ din il-formula.  Din il-formula ghandha timtela kollha u tintbghat flimkien ma’ (1) kopja tal-karta tal-identita tieghek u (2) cekk ta’ €15 lil:Malta Insurance Association
43A/4 St Paul’s Buildings,
Triq il-Punent
Valletta

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