Automobile Accident Report
(보고하는 날짜) July 1, 2018
(보험회사 이름)
Claims Department
(팩스번호) FAX: (000) 000-0000
(교통사고 일자) Date of Accident: June 15, 2018
- Personal Information (개인 정보)
| Name | DOB | ||
| Address | |||
| Phone | |||
- Vehicle Information (자동차 정보)
| Vehicle Make/Model | Year | |||
| License Plate Number | ||||
| Registered Owner of the Vehicle | ||||
- Accident Details: See Police Report. (경찰 리포트 첨부)
(본인 영문 이름) Date