4. Đc đi m, tình tr ng ặ ể ạ hàng hoá trên ph ng tiên: (n u có liên quan đn taiươ ế ế
n n)ạ
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5. Thu mâu vât đê yêu c u giam đinh: (nêu co) ầ
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Trong qua trinh kham nghiêm ph ng tiên chung tôi đa ve s đô (nêu co), ươ ơ
chup anh va ghi hinh (nêu co).
Vi c khám nghi m ph ng tiên k t thúc h i ệ ệ ươ ế ồ ….. gi ờ….. phut, ngày ….. tháng …..
năm ……. Biên ban nay đã đc l i cho nh ng ng i có tên trên nghe, công nh n đúng, ọ ạ ữ ườ ậ
ký tên xac nhân d i đây. ướ
NG I CÓ LIÊN QUAN TRONG VƯỜ Ụ
TAI N N GIAO THÔNGẠ
(Ký, ghi rõ h tên)ọ
NG I TI N HÀNH KHÁM NGHI MƯỜ Ế Ệ (6)
(Ký, ghi rõ h tên)ọ
NG I CH NG KI NƯỜ Ứ Ế
(Ký, ghi rõ h tên)ọ
NG I L P BIÊN B NƯỜ Ậ Ả
(Ký, ghi rõ h tên)ọ
NG I THAM DƯỜ Ự
(Ký, ghi rõ h tên)ọ
(6) Cán b đc phân công xác minh, gi i quy t v tai n n ky tên.ộ ượ ả ế ụ ạ
M u sô 08/TNĐBẫ
Ban hanh theo Thông t sô 63/2020/TT-BCA ư
ngày 19/6/2020
..............................................(1)
..............................................(2)
C NG HOÀ XÃ H I CH NGHĨA VI TỘ Ộ Ủ Ệ
NAM
Đc l p - T do - H nh phúcộ ậ ự ạ
…….…, ngày……tháng……năm………
BIÊN B N KHÁM NGHI M PH NG TI N Ả Ệ ƯƠ Ệ
LIÊN QUAN ĐN V TAI N N GIAO THÔNG ĐNG BẾ Ụ Ạ ƯỜ Ộ
Hôi .…. gi .…. phut, ngày ….. tháng ….. năm …….. tai ờ (3) ……………………
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Chung tôi gôm:
Ông/bà: .............................................................................................................................
thuôc C ơ
quan ...................................................................................................................
Ông/bà: .............................................................................................................................
thuôc C ơ
quan ...................................................................................................................
Ông/bà: .............................................................................................................................
là ng i có liên quan trong v tai n n giao ườ ụ ạ
thông............................................................
Ông/ba: .............................................................................................................................
.......................................................................................................... la ng i ch ng ươ ư
kiên
V i s tham d cuaơ ư ư (4):
Ông/bà ………………………... ………..………………………………………………
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Ông/bà ………………………... ………..………………………………….…………...
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Ông/bà ………………………... ………..…………………………….………………...
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ti n hành khám nghi m ph ng ti n ế ệ ươ ệ (5) ................................ bi n s ể ố ............................... liên quan
v tai n n giao thông x y ra h i ụ ạ ả ồ ….. gi ờ….. phut, ngày ….. tháng ….. năm ……. t i ạKm
(sô nha), đng (phô); khu gian, ga, thu c thôn ( p), xa (ph ng, th tr n), huyên ươ ộ ấ ươ ị ấ
(quân, thi xa, TP thu c tinh), t nh (TP tr c thu c Trung ng) ộ ỉ ự ộ ươ ....
…..................................................................
……...……………………………………….…………………………………………………………………………………….
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1. V gi y t và đc đi m c a ph ng ti nề ấ ờ ặ ể ủ ươ ệ
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(1) Tên c quan c p trên; (2) Tên c quan l p biên b n; (3) Đia điêm lâp biên ban; (4) Co thê la cán b k ơ ấ ơ ậ ả ộ ỹ
thu t hình s , nha chuyên môn, phiên dich; cán b c p xã, ph ng th tr n; ng i co liên quan đên vu tai nan ậ ự ộ ấ ườ ị ấ ươ
giao thông; (5) Ô tô, mô tô, xe thô s , …..ơ
.
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2. Khám nghi m cac d u v t liên quan đên vu tai nan giao thông đê lai trên ệ ấ ế
ph ng tiên: (ghi rõ v trí, tên g i, màu s c, kích th c, chi u h ng, cao th p vàươ ị ọ ắ ướ ề ướ ấ
đnh v v trí c a chúng):ị ị ị ủ
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3. Ghi nhân an toàn ky thuât cua ph ng ti n: ươ ệ
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