Sample document confirming an accident on the way to and from home to work in Vietnam

Sample document confirming an accident on the way to and from home to work in Vietnam (Image from the Internet)

What are regulations on sample document confirming an accident on the way to and from home to work in Vietnam?

According to Appendix IV Sample document confirming accident on the way to and from home to work issued with Circular 28/2021/TT-BLDTBXH as follows:

SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
---------------

.............., day month Year ......

WRITTEN CONFIRMATION

Regarding confirmation of having an accident on the way to and from home to work

Dear:

- People's Committee of commune, ward, town... ⁽¹⁾

- Commune, ward, town police... ^(first)

I. INFORMATION ABOUT THE PROPOSAL

1. Full name: …………………..………………………………………………………………….......... ................................................................ ......

2. Date of birth: ………………..………. Gender ………………………………….

3. Address of residence: …………………................................... ................................................................ ..........................

4. Phone: ................................................ ................................................................ .....................

5. Identity card or citizen identification card number: ….……………………………………................... .................................

Date and place of issue: …………….……………….......................... ................................................................ ................

6. Relationship with the accident victim: ⁽²⁾ : …………………. ……………………………………............................................ ..........................

………………………………………………………………………............................ ................................................................ ..........................

II. REASONS AND BASIS FOR PROPOSAL

I would like to present the situation as follows ⁽³⁾ :……………………………………............................ ................................................................ ....

…………………………………………………………………………………………………………………………………………….. ................................................................ .............

…………………………………………………………………………………………………………………………………………….. ................................................................ .............

……………………………………………

However, due to ⁽⁴⁾ ……………………………………………………. . . . . . . . . . . . . . . . . . Therefore, there is no traffic police force to examine the scene, only the People's Committee/police and order agency of the commune, ward, town……………. ⁽⁵⁾ check and record the incident.

Pursuant to the provisions of Point c, Clause 5, Article 35 of the Law on Occupational Safety and Hygiene, Article 23 of Decree No. 39/2016/ND-CP dated by the Government, to prepare a record of investigation of occupational accidents for In case of a traffic accident related to work, one of the following documents can be based on: Written confirmation of the accident from the commune-level police agency where the accident occurred; or written confirmation of accident from the local government where the accident occurred.

III. RECOMMENDED CONTENT

For the above reasons and grounds, I request you ⁽⁶⁾ …………………………………………… to confirm the above accident with the following information:

1. Time of accident: … hour ... minute ... day ... month ... year ... ⁽⁷⁾ ;

2. Place of accident: ……………………………………. ⁽⁸⁾

3. Information about the accident victim:

a) Full name: …………………..……………………………………….................... ................................................................ ................

b) Date of birth: ………………..………. Gender ……………

c) Identity card or citizen identification card number: ….…………................................. .................................................

Date and place of issue: …………….……………….......................... ................................................................ ................

4. Preliminary developments of the accident: ………………………………………………………………………………………………. ................................................

…………………………………………………………........................………………………………... ................................................................ ..................

……………………………………………………………………………………………………………………... ................................................................ ..................

…………………………............………………………………………………………………... ................................................................ ..................

…………................................................. ................................................................ ................................................................ .....

5. Status of the victim's injuries immediately after the accident (if determined):

……………………………………………………............................ ................................................................ ................................……

CONFIRMATION OF THE PEOPLE'S COMMITTEE/COMMUNE LEVEL POLICE AGENCY

1. Confirmation of the accident ⁽⁹⁾ : confirm the information in your application

……………….…..................................... To be ………. . ⁽¹⁰⁾ .………………………………………………………….............……………...

…………………………………………………………………………............……………………… ………………………………………………

………………………………………………………………............…………………………… ………………………………………………

2. Other additional opinions about the accident (if any): ………................................. ................................................

.................................................................................................... ................................................................ ...............

.................................................................................................... ................................................................ ...............

.................................................................................................... ............

Note

(1) Record specifically the names of the People's Committee and the police agency of the commune, ward or town where the inspection was conducted and the incident recorded as soon as it occurred (must be consistent and consistent with the content of the description in Part II of the application)

(2) If the person writing the application is the victim, this content does not need to be written. If the person writing the application is a relative of the victim, clearly state the relationship with the victim such as parent, brother, sister, spouse, colleague, etc.

(3) State a summary of the facts in accordance with the developments of the case stated in Point 4, Part III of the Application; includes the following basic information: Work and ongoing actions of the victim when the accident occurs; Preliminary reasons and factors causing the accident, injury or damage to the parties immediately (if determined immediately when the accident occurred)...

(4) Clearly state the reason why there was no traffic police force to examine the scene, for example: simple accident, minor injury, because the accident occurred in a remote, remote location, few people pass by...

(5) Clearly state the name of the agency conducting the inspection and recording the incident

(6) Clearly state the name of 01 agency (or People's Committee or commune-level police agency) requesting confirmation (one of the agencies conducting the inspection and recording the incident).

(7) In case the time cannot be determined exactly, write the time period: from .... to...

(8) Record specific information: house number, street (or kilometer number... avenue), village, hamlet group, commune/ward, town, district, province/city...

(9) Clearly state the name of an appropriate certifying agency according to the application, which is the People's Committee or the commune-level police agency.

(10) Record according to 01 of 02 following cases:

- In case there is enough information to confirm that the contents in the application are true, write "Confirming that the information in Mr./Mrs. ……………….......'s application is true".

- In case there is not enough information to confirm that the contents in the application are true or in fact, the agency does not send people to check and record at the scene as soon as the incident occurs, then clearly state "There is not enough basis to confirm that the information in Mr./Mrs. ……………….......'s application is true" and at the same time clearly state the reason or state the inaccurate content. .

Best regards!