Av. Kenneth Kaunda, 518, Maputo
mcs@mcs.co.mz
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Home page
MCS
Personal
Car Insurance
Health Insurance
Personal Accidents Insurance
Travel Insurance
Family Protection Insurance
Multi-risk and home insurance
Corporate
Car Insurance
Health Insurance
Personal Accidents Insurance
Industry and Commerce Multi-Risk
Travel Insurance
School Personal Accidents Insurance
Documents
Claim Report Documents
Claim Reports
Branches
Contacts
News
FAQ’s
MOÇAMBIQUE COMPANHIA DE SEGUROS
CAR ACCIDENT REPORT
1.Date of accident
*
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*
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*
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2.PLACE (Road/street, town and county)
*
3. Were there any injuries, even minor ones?
4. Was there any material damage other than to vehicles A and B?
5. WITNESSES, Names, addresses and telephone numbers
*
VEHICLE A
VEHICLE B
6. INSURED
6. INSURED
7. VEHICLE
7. VEHICLE
8. MOÇAMBIQUE COMPANHIA DE SEGUROS
8. MOÇAMBIQUE COMPANHIA DE SEGUROS
Card valid until
*
Card valid until
*
9. DRIVER
9. DRIVER
11. VISIBLE DAMAGE
*
11. VISIBLE DAMAGE
*
12. CIRCUMSTANCES OF THE ACCIDENT
It was parked
It was leaving the parking lot
It was about to park
It was coming out of a private parking lot or a private driveway
It was entering a parking lot, private place or private road
It was entering a traffic circle or turning square
It was driving on a traffic circle or turning square
It crashed into the back of another vehicle traveling in the same direction and same queue
It was driving in the same direction but in a different queue
It was changing queue
It was overtaking
It was turning left
It was turning right
It was going backwards
It was driving on the part of the road reserved for oncoming traffic
It was coming from the left (at a crossroads or junction)
Didn't respect a signal to give priority
12. CIRCUMSTANCES OF THE ACCIDENT
It was parked
It was leaving the parking lot
It was about to park
It was coming out of a private parking lot or a private driveway
It was entering a parking lot, private place or private road
It was entering a traffic circle or turning square
It was driving on a traffic circle or turning square
It crashed into the back of another vehicle traveling in the same direction and same queue
It was driving in the same direction but in a different queue
It was changing queue
It was overtaking
It was turning left
It was turning right
It was going backwards
It was driving on the part of the road reserved for oncoming traffic
It was coming from the left (at a crossroads or junction)
Didn't respect a signal to give priority
13. ACCIDENT SCHEME
*
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14. OBSERVATIONS
9. INJURED (including minor injuries)
Signature of Driver A
*
Signature of Driver B
*
1. INSURED
2. DRIVER
Are you the usual driver of the vehicle?
Yes
No
3. DETAILED DESCRIPTION OF THE ACCIDENT
*
Indicate how fast your vehicle was going:
*
10. The driver of the other vehicle, as well as the owner of the property hit, or any of the injured, is:
Relative
Partner
Employee
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