Ta: REPUBLIC OF KENYA aa THE KENYA POLICE ABSTRACT FROM POLICE ON A ROAD ACCIDENT ise. “te. Divison, Date. ASL Our ref VO oo poiice ret >, n accident involving... ive uiftlertand thatgaur Paice 5 eda report ofa | we fest el fa pt aeecrl | i i- { i SA ae The officer i/c .. AO Baw peace ees ea n (date), Selene at gen YS AEG r involving vehicle(s) ny eR Beek OY Ssh. mal... and. ac misao MBBS ES, Name of police ete where er) reported. From the record coyletyou please furnish us with the foliowing, ink matin: = ‘ pe Voie Or. Ascot 1 Io\ware and ders ee cis peers i mys covey lb). Name of the Insurance Conpanypavl 2, Has the investigation been corp? Yuet gpg eto pr\pses pate if so, has anyone been charged? Yes /No. Roy Aoicle Of, if this case Is stl under investigation starz ieloa of ethene ey welng prosecu' 4? ce 3. If tis intended to prefer charges, state: (Qe Ser ai Tao fal Name of driver/cyclist/pedestrian... A DEY {a] Vehicle registration No, 4 Name at charge... 5, Caurt Case File No.. 6, Name of Investigation Offcer.. 7. Result of investigations or anal 8. Accident ee ae (armen ; x “age of Witneséeg ) i oe ees Ae cand ate Address 11. When completed, this form is to be returned to: Name and adgress of 'nsurance Company. Legal Repre: OT" signature of Person/Company Applying for the 2b: ‘when epplying forward in triplicate to officer i/c Division, sake : ney Re: ,