Get An Appointment EFFECTED PERSON DETAIL: Fill out the form below and one of our representative will get in touch with you very soon. APPLICANT INFORMATION Name Place Of Birth CNIC Gender Male Female Address Phone Number E-Mail CASE DEATAILS FIR NO: Under section Police Station Date of Incident Location of Incident Description of Incident Police Report Filed Yes No Any other relevant details LEGAL INFORMATION Familiarity with Fatal Accidents Act 1855 Yes No Have you sought legal advice regarding this incident? Yes No Type of Injury Severity of Injury Medical Treatment Received Cause of the Incident Death Confirmation Date of Death Witness Of Incident Circumstances of Accident EFFECTED PERSON DETAIL Is the Individual: Deceased Alive Full Name of Injured/Deceased Person Age Place of Birth Contact No Email CNIC Residential Address Own/Rented House Company Name Nature of Employment Private Government Job Title/Position Monthly Income Work Address Martial Status Spouse Name Spouse Contact No Spouse CNIC No Number’s of childrens Age of Elder child Age of Youngest child Father Name (late/Alive) Mother Name (late/Alive) Father Contact No Mother Contact No Submit