Page 701 - The Central Motor Vehicles Rules, 1989

ANNEXURE-XIII THE CENTRAL MOTOR VEHICLE RULES, 1989 673

iv. Cell Phone Driving? Yes No Not Known
v. Severity Fatal
Grievous Injury
Simple Injury Hospitalized
Simple Injury Non-Hospitalized
No Injury
vi. Seatbelt/Helmet Yes No Not Known
vii. Drunk Driving Yes No Not Known
viii. Mode of Transport 108 Ambulance
Not Hospitalized
By Self
Private Ambulance
Private Vehicle
ix. Hospitalization delay <30 Minutes
>30 Minutes <1 Hour
>1 Hour > 2 Hours
>2 Hours
Not Hospitalized
x. Driving License Type Known
Unknown
Without License
LLR
Not Applicable
Juvenile
Verification:
Verified at ........................................... on this ...................... day of ...................... that the
contents of the above Form are true to my knowledge and the documents attached are
true copies of their originals.
Documents to be attached:
i. ID/address proof
ii. Driving Licence
iii. Insurance Policy
FORM-IV
OWNER’S/INSUREDS FORM
By Owner of the vehicle(s) to Investigating Officer
Within thirty (30) days of Accident
Copy to the Victim(s) and Insurance Company
FIR No.
Date

Under Section
Police Station