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 |
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| 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. |
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| 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? | Yes/No | IVA / LE | Sofrejt hsara materjali f’dan l-incident? | ||
| Did you incur bodily injuries in this accident? | Yes/No | IVA / LE | Korrejt f’dan l-incident? | ||
| DETAILS OF VEHICLE | A | B | DETAILS OF VEHICLE | ||
| DETTALJI VETTURA | DETTALJI VETTURA | ||||
| Vehicle registration number | Numru ta’ registrazzjoni tal-vettura | ||||
| Make/Model | Ghamla/Mudell | ||||
| Name and Surname of vehicle owner | Isem u Kunjom ta sid il-vettura |
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| DETAILS OF THE APPLICANT | DETTALJI TAL-APPLIKANT | ||||
| Name and Surname | Isem u Kunjom | ||||
| Identity card number (copy attached with this application) | Numru tal-karta tal-identita (kopja ma’ din l-applikazzjoni) |
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| 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 €21.78 (VAT included) should be sent to: Insurance Association Malta, 43A/4 St Paul’s Buildings, West Street, Valletta Payment can be effected via Bank Transfer using the following details: IBAN No:MT90VALL22013000000040015137957 Bank’s BIC: VALLMTMT |
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) Pagament ta, cekk ta’ €21.78 (VAT inkluza) li ghandu jintbaghat lil: Insurance Association Malta, 43A/4 St Paul’s Buildings, Triq il-Punent, Valletta Il-pagament jista jsir b’trasferiment billi tuza dawn id-dettalji: IBAN No: MT90VALL22013000000040015137957 Bank’s BIC: VALLMTMT |
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