FORM -1

INTIMATION OF THE ROAD ACCIDNET BY THE INVESTIGATING OFFICER

TO THE CLAIMS TRIBUNAL AND THE INSURANCE COMPANY

1	FIR No. date and under section
2	Name of the Police Station
3	Date, time and place of the accident
4	Source of Information (Name, Address & Tel. No ) (a) Driver/Owner (b) Victim (c) Witness (d) Hospital/Medical Facility
5	Nature of the accident: (a) Whether resulted in death or injury or both? (b) Number of persons injured/died (c) In case of Injuries, whether simple or grievous?
6	Name and address of the injured/deceased
7	Details of the hospital where taken
8	Registration of the vehicle(s) involved in the accident
9	Name, address and contact no. of the owner of the offending vehicle(s)
10	Name, address and contact no. of the driver of the vehicle(s)
11	Insurance Policy Number
12	Period of Insurance Policy
13	Name and address of the Insurance Company
14	Name and contact no. of the Investigating Officer

Enclosed-Copy of FIR

SHO/IO

PS

FORM –II

DETAILED ACCIDENT REPORT (DAR)

PART-1 PARTICULARS OF THE ACCIDENT
1	FIR No. date and under section
2	Name of the Police Station
3	Offences as per report under section 173 CrPC
4	Date, time and place of the accident
5	Who reported the accident to the Police? (Give Name, Address & Contact No.) (a) Driver/Owner (b) Victim (c) Witness (d) Hospital/Medical Facility
6	Name of the person who took the victim to the hospital, name of the hospital and at what time
7	Whether any hospital denied treatment to the victim?
8	Nature of the accident: (a) Whether resulted in death or injury of both? (b) Number of persons inured/died
9	Particulars of the offending vehicle(s)
10	Number of persons in the offending vehicle(s)
11	Whether the victim was: (a) Pedestrian/bystander (b) Cyclist (c) Scooterist (d) Travelling in a vehicle. If so, whether at driving seat, back seat, front seat, side car, travelling at rear guard cargo area, etc. (e) Victim’s vehicle no. (f) No. of persons in the victim’s vehicle
12`	Name and contact number of the investigating Officer
13	Name of witnesses of the accident
14	Brief description of the accident
15	Site Plan shall indicate:

PART-1

PARTICULARS OF THE ACCIDENT

16

Site Plan shall indicate:

(i) Place of accident
(ii) Position of vehicle(s)
(iii) Position of victim(s)
(iv) Skid marks
(v) Road-Whether one way or two way
(vi) Lane in which the accident took place
(vii) Permissible speed limit on the road at the site of the accident
(vii) Permissible speed limit on the road at the site of the accident
police officer, road markings, warning sign, stop sign were there
(ix) Location of zebra crossing or pedestrian zone
(x) Whether near traffic lights? If so, whether functional?
(xi) Distance of speed breakers, if any, from the spot of accident (xii) Width and type of road-national highway/city road/expressway/rural road, etc
(xiii)

Direction of the vehicle(s):

(a) Same direction (rear end)
(b) Same direction (side swipe)
(c) Right angle
(d) Opposite direction (angular)
(e) Opposite direction side swipe
(f) Struck parked vehicle
(g) Left turn
(h) U-turn reversing

(xiv)

Directions of movement of the Vehicle

(a) North
(b) East
(c) South
(d) West

(xv)

Road Divided by

(a) Barrier Median
(b) Curbed Median
(c) Grass Median
(d) Painted Median
(e) None

(xvi)

Light Condition

(a) Daylight
(b) Dusk
(c) Dark (No Street Lights)
(d) Dark (Street Lights On, Spot)
(e) Dawn
(f) Dark (Street Lights Off)
(g) Dark (Street Lights On, Continuous)

(xvii)

Visibility/Environmental Condition

(a) Clear
(b) Fog/Smog/Smoke
(c) Snow
(d) Severe Crosswinds
(e) Rain
(f) Blowing Sand or Dirt
(g) Sun Glare

(xviii)

Road Character

(a)Straight and Level
(b) Straight and Grade
(c) Straight and Hillcrest
(d) Curve and Level
(e) Curve and Grade
(f) Curve and Hillcrest
(g) Under construction/maintenance

(xix)

Road Surface Type

(a) Concrete
(b) Blacktop
(c) Gravel
(d) Steel Grid
(e) Dirt
(f) Pot Holes
(g) Pot Holes
(h) Construction Material on Road

(xx)

Road Surface Condition

(a) Dry
(b) Wet
(c) Snowy
(d) Water (standing/moving)
(e) Sand, mud, dirt
(f) Oil

(xxi)

Airbag Deployment

(a) Front
(b) Side
(c) Multiple
(d) None
(e) Dawn

(xxii)

Ejection from Vehicle

(a) Not ejected
(b) Ejected
(c) Partial Ejection
(d) Trapped

(xxiii)

Temporary Traffic Zone

(a) None
(b) Construction zone
(c) Maintenance zone
(d) Utility zone
(e) Incident zone

(xxiv)

Total Number of entities involved in the crash

Crash Type:

With other motor vehicle as first event:

(a) Same Direction (Rear End)
(b) Same Direction (Slide Sweep)
(c) Right Angle
(d) Opposite Direction (Here on, Angular)
(e) Opposite Direction (Slide Sweep)
(f) Struck Parked Vehicle
(g) Left Turn/U Turn
(h) Backing
(i) Encroachment

With below as first event:

(a) Overturn
(b) Fixed Object
(c) Animal
(d) Pedestrian
(e) Pedal Cyclist
(f) Non-fixed Object
(g) Railcar Vehicle

PART-III PARTICULARS OF THE DRIVER(S) (In case of more than one driver, submit separate Part III for each driver)
17	Name and contact number of the investigating Officer
18	Age
19	Gender
20	Education
21	Occupation
22	Family
23	Income (monthly)
24	Account number with name and address of the bank in which the driver is maintaining his account
25	Driving Licence: (a) Driving License Number (b) Whether learner license (c) Period of validity (d) Issued by (e) Class of vehicle (f) Whether license suspended or cancelled?
26	In case of learner’s license: (a) Whether driving under supervision (b) Whether driving with lapsed learner license
27	Whether driver is the owner/paid driver/otherwise?
28	Whether driving with the knowledge/consent of the owner?
29	Whether driving under influence of liquor/drugs? Whether finding based on scientific report?
30	(a) Whether the driver reported the accident to the police/family of the victim? (b) Whether the driver took the victim to the hospital? (c) Whether the driver visited the victim at the hospital? (d) Whether the driver remained at the spot till arrival of the police? (e) Whether the driver did not remove the offending vehicle from the spot till the arrival of the police? (f) Whether the driver paid compensation/medical compensation to the victim/his family? (g) Whether the driver cooperated in investigation? (h) Whether the driver also suffered injuries in the accident? (i) Whether discharged duty under section 132 & 134 of the MC Act, 1988? (j) If no, whether the driver has been prosecuted
	under section 187 MV Act, 1988?
31	Whether the driver fled from the spot? If so, the date on which he appeared before the police/Court or was arrested?
32	Any other relevant information relating to the driver

PART-IV PARTICULARS OF THE OFFENDING VEHICLE (S) (In case of more than one vehicle, submit separate Part-IV for each vehicle)
33	(a) Registration Number (b) Colour (c) Make (d) Model (e) Year (f) Engine Number (g) Chasis Number (h) Address of the Registering Authority (i) Private or commercial (public service vehicle, goods carriage/educational institution bus)
34	Name, address, occupation and contact number of the owner: (a) In case of company, person in charge in terms Section 199 of the MV Act, 1988 (b) In case of sale of the vehicle, give particulars of the purchaser and date of transfer
35	In case of commercial vehicle: (a) Particulars of fitness (b) Particulars of permit
36	Whether driver employed on monthly or daily basis? Attach the proof of employment of driver such as appointment letter, salary slip, duty register or other relevant documents
37	In case the driver fled from the spot, did the owner produce the driver before the police? If so, when? Attach the copy of the notice under section 133 MV Act, 1988 and its reply
38	Whether the owner reported the accident to the Insurance Company? If so, when?
39	Whether the owner co-operated in the investigation?
40	(a) Whether the owner discharged his duties under section 133 & 134 MV Act, 1988? (b) If so, whether the owner prosecuted under section 187 MV Act, 1988?
41	In the case of un-insured vehicle: (a) Whether the owner/driver prosecuted under section 196 of the MV Act, 1988? (b) Whether the owner/driver made payment of compensation to the victim or his family? Give particulars, if available.

PART-V PARTICULARS OF THE INSURANCE OF THE VEHICLE(S)
42	Policy Number
43	Period of policy
44	Issued by (give name and address of the Insurance
	Company)
45	Nature of policy i.e Third party or comprehensive
46	Name, address and contact number of the Designated Officer of the Insurance Company
47	Date of intimation of the accident by the Investigating Officer to the Insurance Company
48	Date of appointment of the Designated Officer by the Insurance Company
49	Account number with name and address of the bank in which the Insurance company is having its account
PART-VI MECHANICAL INSPECTION OF ALL VEHICLES INVOLVED IN THE ACCIDENT
50	Name and qualification of the Mechanical Officer
51	Date of mechanical inspection of the Vehicle(s)
52	Date of mechanical inspection report(s)
53	Whether the mechanical inspection report is in terms of Annexure-A? If no, give reasons thereof.
54	Whether any delay in mechanical inspection or submitting report? If so, give reasons thereof.
PART-VII IMPACT OF THE ACCIDENT ON THE VICTIM(S) (In case of more than one victim, submits separate Part-VII for each victim)
55	Death Cases: (a) Name and address of the deceased (b) Age (c) Gender (d) Education (e) Occupation (f) Income (monthly) (g) Legal heirs/Guardian: (1) Name (2) Relationship (3) Age (4) Address (5) Contact Number
56	Injury Cases: (a) Name and address of injured (b) Age (c) Gender (d) Education (e) Occupation (f) Income (monthly) (g) Details of family/dependents of the victim (h) MLC No. (i) Nature of injuries (j) Name of hospital(s) where injured treated? (k) Whether victim refused medical treatment (l) Period of hospitalization (m) Period of treatment (n) Whether treatment continuing (o) Name, address and contact number of the doctor(s) who treated the injured (p) Whether injured underwent any surgery(s)? If so, give particulars (q) Whether suffered any permanent disability? If yes, give details (r) Expenditure incurred on treatment, conveyance, special diet, attendant etc. Give details, if available (s) Whether the injured got reimbursement of medical expenses from his employer or under a mediclaim policy. Give details, if available (t) Whether the injured provided cashless treatment by the Insurance Company? Give details, if available
57	Any other relevant information

PART-VIII APPARENT CONTRIBUTING CIRCUMSTANCES
58	Driving without valid driving license
59	Driving while disqualified
60	Learner driving without supervision
61	Vehicle not insured
62	Driving a stolen vehicle
63	Vehicle taken out without the consent of the owner
64	Driving dangerously or at excessive speed
65	Under influence of liquor or drugs. Give quantity/parameters/recovery, if available
66	Dangerously loaded vehicle
67	Parking on the wrong side of the road
68	Parking at prohibited places
69	Non-observation of traffic places
70	Poorly maintained vehicle
71	Fake/forged driving license
72	Previous conviction(s)/past history of bad driving
73	Driving Aggressively: (a) Jumped red light (b) Abrupt braking (c) Neglected to keep to the left of the road (d) Driving criss-cross (e) Driving too close to the vehicle in front (f) Persistent inappropriate attempts to overtake (g) Cutting in after overtaking (h) Racing/competitive driving (i) Crossing speed limit (j) Disregarding any warnings (k) Driving on the wrong side (l) Overtaking where prohibited (m) Driving with loud music (n) Improper reversing (o) Improper passing (p) Improper turning (q) Driving in no entry hours (r) Not slowing down at crossing/road junction (s) Turning without indication (t) Not respecting stop sign on road surface (u) Not respecting light of way to pedestrian (v) Using mobile phone while driving
74	Irresponsible Behavior: (a) Failing to stop after accident (b) Ran away from the spot after having the vehicle (c) Destruction or attempt to destroy the evidence (d) Falsely claiming that one of the victims was responsible for the accident (e) Trying to throw the victim off the bonnet of the vehicle by swerving in order to escape (f) Causing death/injury in the course of dangerous driving post commission of crime or chased by police in an attempt to avoid detection or apprehension (g) Offence committed while the offender was on bail (h) Misled the investigation (i) Post accident road rage behavior, give details. (j) Any other contributing Facts:

PART-IX OTHER OFFENCES COMMITTED AT THE SAME TIME
75	(a) Sections 3/181-Driving without license (b) Sections 4/181- Driving by minor (c) Sections 5/181- Allowing unauthorized person to drive (d) Sections 56/192- Without fitness (e) Sections 66(1)/192(A)- Without permit (f) Sections 112/183(1)- Over speed (g) Sections 113/194- Over loading (h) Sections 119/177- Jumping red light (i) Sections 119/277- Violation of mandatory signs (One way, No right turn, No left turn) (j) Sections 122/177- Improper obstructive parking (k) Sections 146/196- Without insurance (l) Section 177/RRR17(1)- Violation of “One way” (m) Section 177/RRR29- Carrying High/Long Load (n) Section 177/CMVR 138(3)- Not using seat belt (o) Section 177/RRR6- Violation of “No overtaking” (p) Section 177/CMVR 105- Without light after sunset (q) Section 179- Misbehavior with police officer (r) Section 184- Driving dangerously (s) Section 184- Using mobile phone while driving (t) Section 185- Drunken driving/under influence of drugs (u) Section 187- Violation of Sections 132(1) (c ), 133 & 134 (v) Any other offence
PART-X DIRECTIONS REQUIRED FROM CLAIMS TRIBUNAL
76	The driver(s) involved in the accident have not furnished information mentioned in para(s) [ para(s) 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 & 41(b) of Part III] and the documents mentioned in para(s) [para(s) 91, 92, 93, 94, 95, 96, 97 of Part XI ]. The driver(s) may be directed to furnish the requisite information on affidavit along with the original documents before the Claims Tribunal. (Copy of the letter demanding the information/documents be attached)
77	The owner(s) of the vehicles involved in the accident failed to furnished the information mentioned in para(s) [ para(s) 18, 34, 35, 36, 38, 40 & 41(b) of Part IV and have not produced the documents mentioned in para(s) [para(s) 92, 93, 94, 95, 96, 97 of Part XI ]. The owner(s) may be directed to disclose the requisite information on affidavit along with the original documents before the Claims Tribunal. (Copy of the letter demanding the information/documents be attached)
78	The Insurance Company has failed to disclose information mentioned in para(s) [para(s) 46, 47, 48, 49 of Part V] The Insurance Company may be directed to disclose the requisite information on affidavit along with the original documents before the Claims Tribunal. (Copy of the letter demanding the information/documents be attached))
79	The claimant(s) have failed to disclose the information mentioned in para(s) . [ para(s) 55 & 56 of Part VII and the documents mentioned in para(s) [para(s) 101 & 102 of Part XI ]. The claimant(s) may be directed to disclose the requisite information on affidavit along with the original documents before the Claims Tribunal. (Copy of the letter demanding the information/documents be attached)
80	The registration authority have failed to verify documents (registration certificate, driving license, fitness & permit) within 15 days of the application in terms of Clause 5 ofthe modified Claims tribunal Agreed Procedure and therefore, necessary directions be issued to the registration authority to produce the same before the Claims Tribunal. (Copy of the letter demanding the information/documents be attached)
81	Hospital has failed to issue MLC/Post Mortem Report) within 15 days of the accident in terms of Clause 6 and therefore, the necessary directions be issued to the Hospital to produce the same before the Claims Tribunal. (Copy of the letter demanding the information/documents be attached)
82	Specify any other direction that may be necessary

PART –XI RELEVANT DOCUMENTS TO BE ATTACHED
83	First Information Report
84	Site plan in terms of Para 16
85	Photographs of the scene of accident from all angles
86	Photographs of all the vehicles involved in the accident from all angles
87	Photograph and admitted signature of the driver(s) of the offending vehicle(s)
88	Photograph and specimen signature of the owner(s) of the offending vehicle
89	Mechanical Inspection Report in format of Annexure A
90	Driving license of the driver
91	Proof of employment of driver such as appointment letter, salary slips, duty register etc
92	Registration certificate of the offending vehicle(s)
93	In case of transfer of vehicle, sale documents, possession letter or any other document relating to transfer, if any
94	Insurance Policy of the offending vehicle(s)
95	6 Permit (for commercial vehicle)
96	Fitness Certificate (for commercial vehicle)
97	Report under Section 173 CrPC
98	Statements of the witnesses recorded by the police
99	Scientific report, if the driver was under the influence of liquor/drugs

100	In case of Death (a) Post Mortem Report (b) Death certificate (c) Photograph and proof of the identity of the dead (d) Proof of age of the deceased which may be in form of : (i) Birth certificate (ii) School certificate (iii) Certificate from Gram Panchayat (in case of illiterate) (e) Proof of Occupation and income of the deceased which may be in form of : (i) Pay slip/salary certificate for salaried employees. (ii) Bank statements of the last six months. (iii) Income Tax Returns (iv) Balance Sheets (f) Proof of the legal representatives of the deceased (i) Names (ii) Age (iii) Address (iv) Relationship (v) Contact no. (g) Photographs, specimen signatures attested by the bank and identity proof of the legal representatives of the deceased (h) Treatment record, medical bills and other Expenditure (i) Bank Account no. of the legal representatives of the deceased with name and address of the bank
101	In case of Injury (a) MLC (b) Multi angle photographs of the injured (c) Photographs, specimen signatures attested by the bank and identity proof of the injured (d) Proof of age of the injured which may be in form of : (i) Birth certificate (ii) School certificate (iii) )Certificate from Gram Panchayat (in case of illiterate) (e) Proof of occupational income of the injured at the time of the accident which may be in form of: (i) Pay slip/salary certificate for salaried employees. (ii) Bank statements of the last six months of the deceased. (iii) Income Tax Returns (iv) Balance Sheets (f) Treatment record, medical bills and other expenditure–In case of long term treatment, the SHO/IO shall also record the details so that the claimant may furnish documents before the Claims Tribunal. (g) Disability certificate (h) Proof of absence from work where loss of income on account of injury is being claimed, which may be in the form of: (i) Certificate from the employer (ii) Extracts from the attendance register (i) Proof of reimbursement of medical expenses by employer or under a Mediclaim policy, if taken
102	Copy of the letter of the Investigating Officer demanding the relevant information/documents from the driver as mentioned in para 77 above

103	Copy of the letter of the Investigating Officer demanding the relevant information/documents from the owner as mentioned in para 78 above
104	Copy of the letter of the Investigating Officer demanding the relevant information/documents from the Insurance Company as mentioned in para 79 above
105	Copy of the letter of the Investigating Officer demanding the relevant information/documents from the claimants as mentioned in para 80 above
106	Copy of the letter of the Investigating Officer demanding the relevant information/documents from the registration authorities as mentioned in para 81 above
107	Copy of the letter of the Investigating Officer demanding the relevant information/documents from the hospital as mentioned in para 82 above
108	Any other relevant document(s)

VERIFICATION

Verified at Police Station

on this

of ,

that the contents of the above report are true and correct as per information and documents gathered during investigation

Station House Officer

(Name and Stamp)

Dy. Superintendant of Police

(Name and Stamp)

Form 54