Traffic Accident Investigation Report Form

LETTER HEAD

OFFICE NAME

File No:

TRAFFIC ACCIDENT INVESTIGATION REPORT I. WHERE

:

II. WHEN

o : Wednesday Day of the Week

III. WHAT

:

October 10, 2008 Date(Mo/Day/Yr)

Vehicle vs:

x Another Vehicle Pedestrian IV. TYPE OF ACCIDENT: x FATAL V. NUMBER OF VEHICLES INVOLVED:

Type Make/Model Plate No. Classification Name of Driver Address Occupation License No. Age Sex/Status Driving Experience Vehicle Owner File Number Damages

9:30am

Fair

Time

Weather Condition

Animal Drown Vehicle NON-FATAL

Fixed Object Other DAMAGE TO PROP

Two (2) Vehicles

Vehicle #1 (V-1) : Motorcycle/Scooter : Honda Wave Model 2005 : : Private : :

Vehicle #2 (V-2) Mini-SUV Honda CRV

: : : : :

Engineer D04-0729 yrs old Male / Married 10 yrs

Accounting clerk N26-08-014193 31 years old Male / Married 15 yrs

: Same as above : 1344-00000162850 : Multiple

Private

Same as above 1344-00000150888 Front Bumper/Right Fender/ Undercarriage

FACTS OF THE CASE: Investigation disclosed that on the above stated TDPO, V-1 travelling North-West irection along Dormitory Lane turning right as NPC Avenue when it was bumped and hit by V-2 travelling East direction along Escarcha Drive while turning left at NPC Avenue. As a consequence thereof, V-1 Driver 1 sustained severe head injury and was rushed to Taguig-Pateros District Hospital for treatment but pronounced dead-on-arrival (DOA) by the attending physician. Driver-2 voluntarily surrenders to police authority. DISPOSITION: For appropriate filing of charge before Taguig City Prosecutor’s Office.

Noted by:

Investigator-On-Case Chief, NFSTI-TEU