MILLICOM GHANA LTD.

FLEET AND ADMINISTRATION

ACCIDENT SCENE REPORT FORM
Name of Driver/ User:
Vehicle Registration No.:Date of AccidentTime.
Location of the Accident:.

DETAILS FOR OTHER VEHICLE(S) INVOLVED

Name of Driver:
Address and Contact of Driver........................
.
Name of Vehicle Owner:
Address and Contact of Vehicle Owner...........
.
Vehicles Registration No.:..
Make of Vehicle:. Model of Vehicle:.
Insurer of third party vehicle:
Insurers address and contact:..
Details of damages on this vehicle:
.

Name of Police Station reported:

Name and contact of Police officer in charge of case:.
Narration of how the accident happened:.
.
.

PTO.

.
.

.
.

Signature of Driver/UserDate: