Дата ................ 20.....г.
ДО
НАЧАЛНИКА НА РУ -............
ОДМВР ......................................
СЪОБЩЕНИЕ
ЗА ИЗВЪРШЕНО ПРЕСТЪПЛЕНИЕ
ОТ………………………………...................................………………………………………………..…..……………………………………………..……………………………………………….............................. (посочват се данни за заявителя - три имена, ЕГН/ЛНЧ/дата
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на раждане, актуален адрес, телефон за връзка)
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ГОСПОДИН /ГОСПОЖО/НАЧАЛНИК,
На..................................……………………...……………………….............................................................. (посочва се дата - кога е извършено ПТП, час или период от време)
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(място- къде е извършено ПТП)
..................................................................................................................................................................................................................................................................... (при какви обстоятелства е извършено ПТП)
.................................................................................................................................................................................................................................................................. (данни за пътните превозни средства, участвали в ПТП (вид, модел, рег. номер, цвят)
………………………………………………..………………………………………………..………………………………………………...................................... ………………………………………………..………………………………………………..………………………………………………...................................... ………………………………………………..………………………………………………..………………………………………………...................................... (има ли пострадали и кои са те; какви телесни увреждания са причинени на пострадалите)
………………………………………………..………………………………………………..………………………………………………...................................... ………………………………………………..………………………………………………..………………………………………………......................................
To Chief of
Regional Police Department…………………..
MoI Regional Directorate …………
C R I M E R E P O R T
From………………………………...................................………………………………………………..…..……………………………………………..……………………………………………….............................. (claimant’s full names, date of birth, current address,
......................................................................................
telephone number for contacts)
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SIR / MADAM,
On..................................……………………...………………………..............................................................
(date of road traffic accident (RTA), hour or time period)
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(location of RTA)
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(Circumstances of RTA)
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(information about vehicles involved in the RTA – make/type, model, registration number, color)
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(identity of victims, if any, bodily injuries caused)
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(какви материални щети са нанесени в резултат на ПТП)
………………………………………………..………………………………………………..………………………………………………...................................... ………………………………………………..………………………………………………..………………………………………………...................................... ………………………………………………..………………………………………………..………………………………………………...................................... (има ли данни за употреба на алкохол от някой от участниците в настъпилото ПТП)
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(други обстоятелства, които могат да имат значение, включително наличие на свидетели)
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Прилагам следните документи:
1.………………………………………………..……
2.…………………………………………..…………
3.……………………………………...........................
Съобщението е попълнено:
1. Собственоръчно от заявителя
2. От служителя, който го е приел
(Вярното се подчертава)
…………… 20 …. год.
ЗАЯВИТЕЛ: ……………….....................................
………………………………………..
(име, фамилия, подпис)
гр. ……………………
Приел съобщението: .................................................
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(длъжност, име, фамилия)
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(подпис)
………………………………………………..………………………………………………..………………
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(material damage as result of the RTA)
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………………………………………………..……… (evidence about alcohol used by any of the RTA participants)
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(other circumstances of importance, including presence of witnesses)
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I am attaching the following documents:
1.………………………………………………..……
2.…………………………………………..…………
3.……………………………………...........................
The report was filled in:
1. By the claimant in person
2. By the receiving officer
(Underline the correct one)
Date…………20 ….
CLAIMANT: ……………….......................................
………………………………………..
(names and signature)
Place:……………………
Receiving officer: .......................................................
.....................................................................................
(position, name, last name)
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(signature)