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Rodrigo Jimenez CREFITO 122314 Cascavel, ______ de ____________________ de 20____. Declaro para os devidos fins que o (a) Sr(a)___________________________________________, sofreu um acidente de trânsito na data de _______/_______/_______sendo atendido (a)no________ _______________________________________________________________________ ________________, apresentando___________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ________________________________________________ Sendo realizado tratamento_____________________________________________________________ _ _______________________________________________________________________ _______________________________________________________________________ ________________________________ O (A) periciado(a) segue com limitações e reduções funcionais (Dor, FM, ADM):___________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Rua General Osório, n° 2567, Ciro Nardi, Cascavel - PR

Pericia Dpvat Modelo

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Modelo para pericias administrativas, realizadas por empresas de acessoria (aquelas que cobram 30% das vitimas de acidente para dar entrada e receber o dpvat) não é para ser utilizada em casos judiciais.

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Page 1: Pericia Dpvat Modelo

Rodrigo JimenezCREFITO 122314

Cascavel, ______ de ____________________ de 20____.

Declaro para os devidos fins que o (a)

Sr(a)___________________________________________, sofreu um acidente de trânsito

na data de _______/_______/_______sendo atendido (a)no________

_____________________________________________________________________________________

__,

apresentand

o____________________________________________________________________________________

_____________________________________________________________________________________

________________________________________________________________________________

Sendo realizado

tratamento______________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

____

O (A) periciado(a) segue com limitações e reduções funcionais (Dor,

FM, ADM):___________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Rua General Osório, n° 2567, Ciro Nardi, Cascavel - PR

Page 2: Pericia Dpvat Modelo

Rodrigo JimenezCREFITO 122314

_____________________________________________________________________________________

______________________

__________________________Rodrigo Jimenez

CREFITO 122314

Rua General Osório, n° 2567, Ciro Nardi, Cascavel - PR