Accident Statement:
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No people injured in the result of the accident.
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If two motor vehicles are involved in the accident. If more than two motor vehicles are involved in the accident, or if the vehicle drivers cannot come to an agreement on all the significant circumstances of the accident and complete the Accident Statement, the drivers must act according to the Traffic Regulations: turn on the emergency alarm, place the emergency triangle, report to the police and then act according to the instructions of the police.
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No damage is caused to a third party’s property.
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Motor vehicles are not damaged so that they can not or are not eligible to participate in the road traffic.
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If the parties are able to agree upon all the significant circumstances.
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If none of the drivers are under alcoholic intoxication or influence of other intoxicating substances.
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Accident Statement is completed in 2 copies – one original copy and one carbonless copy.
Attention!
Every vehicle driver involved in the road traffic accident (hereinafter - the TrA) must complete the left-or right-hand side (blue or yellow) of the form, which includes columns VEHICLE A or VEHICLE B and tick the left-or right-hand boxes of Paragraph 12 (12.ACCIDENT CIRCUMSTANCES).
One of the drivers involved in the TrA must fill in Paragraphs 1 to 5 at the top of the form and fulfil the requirement of Paragraph 13 – draw a sketch „Accident sketch at the collision moment”.
In Paragraph 15 „Signatures of Drivers”, each of the vehicle drivers involved in the TrA must put his/her signature between the letters A and B each on his/her respective side of the form thus confirming correctness of the information contained in the form as well as compliance of the TrA sketch with the real situation. After separation of the copies (original copy and carbonless copy) one of the vehicle drivers involved in the TrA must receive the original copy and the other – the carbonless copy of the Accident Statement.
The sketch must be drawn and the accident circumstances must be reflected precisely in the Accident Statement. The guilty person is not indicated in the Accident Statement. If the Accident Statement is completed accurately and without corrections, it shall be treated as police protocol.
Completed Accident Statement shall be submitted as follows:
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the person who has caused the accident submits the Statement to his/her MTPL insurance company;
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the person who has suffered damage in the result of the accident, submits the Statement to his/ her MVI insurance company or to the MTPL insurance company of the person who caused the accident.