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Applicant Form Specimen

Date:110-12-20
Division:資訊室

Phone: (07) 229-9825 ext. 606
Specimen for Application for Reconsideration of Traffic Accident Adjudication
(formats are unspecified, this specimen is for reference only)

RE:On __________________ (date) at ___________________________________ (location), _______________ (the party involved) and I had a traffic accident. In disagreement with the adjudication results made by the Traffic Accident Investigation Committee of the Transportation Bureau of the Kaohsiung City Government, this application for reconsideration is made by law. Please be advised.
Description
  1. Please state the details of the accident.

  2. Please state the reasons for disagreement with the adjudication.

  3. Please submit the related data and evidence.

 Signature (seal) of Applicant:
Phone:
Address:
Note: Applicants may include the parties involved in the accident, their heirs, statutory representatives and vehicle owners.

Date:
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Address 8F.,No.25,Jhongjheng 3rd Rd.,Sinsing District. 本局地址 07-229-9825
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Updated:114-05-07
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