|
София 1000
ул.”Граф Игнатиев” № 2, ет. 4
тел./ факс: (+359 2) 980 30 49
(+359 2) 980 66 72
e-mail: insfund@mail.orbitel.bg
|
УВЕДОМЛЕНИЕ
за
неимуществени вреди
От......................................................................................................ЕГН ............................................
Адрес ...................................................................................................................................................
..........................................................................................................Тел..............................................
Желая да ми бъде изплатено обезщетение за вреди от ПТП, съгласно приложени документи:
1. Протокол за ПТП №............................./ ............... г.
-
Документи за оказана медицинска помощ и проведено лечение, както следва:.......................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
3. Други догументи: ............................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
4. Свидетелски показания:.................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
Декларирам, че нямам сключена друга задължителна застраховка и не съм получавал суми от виновното лице. Известно ми е, че за неверни данни нося наказателна отговорност по чл. 313 от НК.
Дата: .......................... Уведомител: ......................................
Гр./с. ......................... (подпис)
Сподели с приятели: |