School Accident Form


Policy Number    (Example: MTP/666777)
Expiry Date    
Maximum Limit    
   
Name of Injured Student    
Age    
Address    
Causes & Circumstances
of the Accident 		   
Place of Accident    
Did any Official Authority
Investigate the Accident? 		  Yes     No 
Names of the responsible persons
at the place of the accident 		    
  
Name of the person responsible
of the injured student 		   
Address of the responsible
person of the injured student 		   
E-mail of the responsible
person of the injured student		     
Name of attending Doctor    
Name of Hospital