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?     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
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)
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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