LETTER HEAD

OFFICE NAME File No:

TRAFFIC ACCIDENT INVESTIGATION REPORT

I. WHERE :
o
II. WHEN :
Day of the Week Date(Mo/Day/Yr) Time Weather Condition
III. WHAT : Vehicle Another Animal Drown Fixed Object
vs: Vehicle Vehicle
Pedestrian Other
IV. TYPE OF ACCIDENT: FATAL NON-FATAL DAMAGE TO PROP

V. NUMBER OF VEHICLES INVOLVED: Two (2) Vehicles

Vehicle #1 (V-1) Vehicle #2 (V-2)

Type :
Make/Model :
Plate No. :
Classification :
Name of Driver :
Address :

Occupation :
License No. :
Age :
Sex/Status :
Driving :
Experience
Vehicle Owner :
File Number :
Damages :

FACTS OF THE CASE:

DISPOSITION:

For appropriate filing of charge before Lupon Prosecutor’s Office.

Noted by: Investigator-On-Case

Chief, NFSTI-TEU