За неимуществени вреди



Дата16.05.2017
Размер18.38 Kb.



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.



  1. Документи за оказана медицинска помощ и проведено лечение, както следва:.......................................................................................................................................................

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3. Други догументи: ............................................................................................................................

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4. Свидетелски показания:.................................................................................................................

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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)



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