Page 711 - The Central Motor Vehicles Rules, 1989

ANNEXURE-XIII THE CENTRAL MOTOR VEHICLE RULES, 1989 683

20. Details of medical treatment given to
the deceased, prior to death. Give
details of medical expenses incurred
21. Whether the victim got
reimbursement of medical expenses
from his employer or under a
Mediclaim policy or under any
government cashless treatment
scheme or government insurance
scheme
If yes, provide details
22. Name, Age, Gender, Relation and Marital Status of Legal Representatives of the
deceased
Name Age/ Gender Relation Marital Status
Date of
Birth

i.
ii.
iii.
iv.
v.

vi.
23. Name, Contact Number and Address of Legal Representatives of the deceased
Name Contact Number Present Address as well as
Permanent Address
i.

ii.
iii.
iv.
v.
vi.
24. In case of children below the age of 18 years
Name of Child Details of school Annual Approximate
and class of the School expenditure of the
child fee child
i.

ii.