1- Accident Date Time City: Neighborhood:
2-Accident Location District: Street:
District: Street:
3-Eyewitnesses
Name Surname Address Tel No:
A 8- Mark (x) in the Appropriate Boxes B
VEHICLE A Violating a red light VEHICLE B
4- Driver Information Entering the highway with no vehicles allowed 4- Driver Information
Name Surname: Entering the road used by the traffic coming from the opposite direction Name Surname:
T.R. Identity Number: Passing in a place where there is no crossing (no overtaking) T.C. Identification number:
Driver’s License No. And Class: Failure to comply with the priority of passing at the intersection Driver’s License No. And Class:
Place of Reception (Province/District): Passing at the stop sign of the authorized officer.
Address: to the vehicle in front of you when driving in the same direction and in the same lane Address:
hit from behind
Tel No: Not following the right turn rules Tel No:
5- Vehicle Information Not following the left turn rules 5- Vehicle Information
Brand and Model: Not following the reverse maneuvering rules Brand and Model:
License Plate: Not following the rules of passing (overtaking) Plate:
Usage: Not complying with the pass priority Usage:
6- Traffic Insurance Policy Information Not following the parking rules 6- Traffic Insurance Policy Information
Name and Surname of the Insured: Failure to comply with the Stopping Rules. Name and Surname of the Insured:
T.R. ID No: Breaking into a vehicle parked in accordance with the rules is T.C. Identification number:
Title of Insurance Company: km/h Speed Status km/h Title of Insurance Company:
Agency No:
m. brake track length if detected
m. Agency No:
Policy No.: Policy No.:
TRAMER Document No: TRAMER Document No:
Policy Start-End Date: Policy Start-End Date:
7- The place where the vehicle was hit first 7- The place where the vehicle was first hit
indicate with an arrow (→).
indicate with an arrow (→).
front front
back to back
9- Draw a sketch of the collision location and moment.
10- Driver comments 10- Driver comments
