교통사고 질문지 MVA Case Emergency Questionnaire

1

What is your full name?* This field is required.운전면허증 상의 이름을 입력해 주세요. Please enter your full name as it appears on your formal identification materials.

First Name

Last Name

2

Email* This field is required.생성된 문서를 받으실 이메일 주소를 입력해 주세요. Please enter the email address that you wish to receive your documents.

example@example.com

3

Your details* This field is required.휴대폰 번호, 면허증 번호, 자동차 등록 번호를 입력해 주세요. Please enter your details as required below.

4

Date of accident* This field is required.사고가 발생한 날짜를 입력해 주세요. What date were you involved in the accident?

Date

5

Time of accident사고가 발생한 시간을 입력해 주세요. At approximately what time did the accident occur?

Hour

Minutes

6

Where did the accident occur?* This field is required.사고가 발생한 지역을 아래 메뉴에서 선택해 주세요. Please select from the following options.

7

What kind of accident was it?* This field is required.어떤 사고였는지 아래 메뉴에서 선택해 주세요. Please select from the following options.

8

How many passengers were in your vehicle at the time of the accident?* This field is required.사고 당시 차에 타고 있던 승객이 몇명이었나요? (운전자 제외) Please select from the following options.

9

Who is the at-fault driver?* This field is required.사고 과실이 누구에게 있었는지 아래 메뉴에서 선택해 주세요. Please select from the following options

10

Do you have insurance?* This field is required.대물 보험에 가입되어 있으신가요?

YESNO

11

Who is your insurer?가입되어 있는 보험사를 아래 메뉴에서 선택해 주세요. Please select from the following options

12

Have you commenced a claim through your insurer?* This field is required.보험사에 클레임을 접수했나요?

YESNO

13

What is your claim number?보험사로부터 받은 클레임 번호를 입력하세요. If a claim has been commenced, your insurer would have provided you with a claim number.

14

Have you informed the victim of the claim number?* This field is required.피해자에게 클레임 번호를 알려줬나요?

YESNO

15

Victim's details* This field is required.피해자 정보를 아래에 입력해 주세요. Please enter the victim's details as required below.

16

Does the at-fault driver have insurance? * This field is required.과실 책임이 있는 운전자가 보험에 가입돼 있나요? 잘 모르겠으면 "No"를 선택하세요. If unsure, please select NO.

YESNO

17

Has the at-fault driver commenced a claim through their insurer?* This field is required.과실 책임이 있는 운전자가 보험사에 클레임을 접수했나요? 잘 모르겠으면 "No"를 선택하세요. If unsure, please select NO.

YESNO

18

What is the claim number? 클레임 번호를 입력하세요. 만일 과실 책임이 있는 운전자가 클레임 번호를 알려주지 않았다면, "N/A"라고 입력하세요. If the at-fault driver has not informed you of the claim number, please enter N/A.

19

Do you have insurance?* This field is required.가입한 대물 보험이 있나요?

YESNO

20

Who is your insurer?가입되어 있는 보험사를 아래 메뉴에서 선택해 주세요. Please select from the following options.

21

Have you commenced a claim through your insurer?보험사에 클레임을 접수했나요?

YESNO

22

What is the claim number?보험사로부터 받은 클레임 번호를 입력하세요. If a claim has been commenced, your insurer would have provided you with a claim number.

23

At-fault driver's details* This field is required.과실 책임이 있는 운전자의 정보를 아래에 입력해 주세요. 잘 모르는 항목에는 "N/A"라고 입력하세요. Please enter the at-fault driver's details as required below. If unsure, please type N/A.

24

Do you have insurance? * This field is required.가입한 대물 보험이 있나요?

YESNO

25

Does the other driver have insurance?* This field is required.상대방 운전자가 가입한 대물 보험이 있나요? 잘 모르겠으면 "No"를 선택하세요. If unsure, please select NO.

YESNO

26

Other driver's details* This field is required.상대방 운전자 정보를 아래에 입력해 주세요. 잘 모르는 항목은 "N/A"를 입력하세요. Please enter the other driver's details as required below. If unsure, please type N/A.

27

Photographs of the accident and damage* This field is required.사고 현장 모습과 파손된 부분 및 사고와 관련된 모든 사진을 업로드해 주세요. Please upload any relevant photos of the incident.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

28

Relevant documents사고와 관련된 문서들(수리 비용 및 견적서, 클레임 서류 등)을 모두 업로드해 주세요. Please upload any relevant documents, such as repair costs and quotations, claim documents, etc.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

29

Further information기타 정보를 적어주세요. If you have any further information you would like to tell us, please do so below.

30

Have you or any passenger in your vehicle sustained injuries from the subject accident?해당 사고로 운전자 본인 또는 동승자가 부상을 당하셨나요?

YESNO

31

Do you wish to receive legal advice from us regarding your injuries from the subject accident?* This field is required.부상에 대한 피해 보상을 위해서 박앤코의 변호사로부터 상담을 받기 원하시면 "Yes" 를 클릭해 주세요.

YESNO

32

개인정보 관련 Privacy policy* This field is required.본 서비스를 이용하는 것이 변호사-의뢰인 관계를 의미하지 않으며, 본 서비스는 교통사고로 인한 대물피해로 고통을 겪는 분들을 위한 공공 서비스임을 안내해 드립니다. 법무법인 박앤코는 때에 따라 추가 조언이나 도움을 드리기 위해 연락드릴 수 있음을 사전 고지해 드립니다. 여러분의 개인정보는 안전하게 관리되며, 외부 유출 또는 타 기관과 공유되지 않음을 안내해 드립니다. All and any information that you have provided to us within this form will be read and assessed by us. You may be contacted by our representatives in relation to your accident. We confirm that all personal details and information contained within this form will not be shared or disclosed externally without your express consent or request.

I understand the above and consent that I may be contacted in the future in relation to the information I have provided within this form.

33

서명* This field is required.Your signature is required. Please make sure it has to be identical to your signature in your ID.

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