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民事起诉状(交通事故)

 

原 告         性别    民族        出生年月日              

籍贯                 现住址                                

联系电话                         

 

被 告                            

法定代表人           职务        

住址                             

联系电话                         

 

案由:道路交通事故人身损害赔偿纠纷

 

诉讼请求:

  1.                             

  2.                              

  3.                              

  4.                             

  5.                              

  6.                             

  7.                             

  8.                             

事实与理由:

事故发生时间:            ,事故发生地点:                                                                                  

肇事双方:                                                                     

责任认定:                                                                     

伤者医疗状况:                                                                                              

死者家庭生活情况:                                                                     

医疗丧葬费用情况、误工、看护费用情况:                                                                     

                                                                   

其他事实:                                                                      

                                                                           

                                                                      

                                                                      

                                                                      

                                                                      

                                                                       

此致

    区人民法院

 

附:本起诉状副本  

    交通事故责任认定书复印件  

 

 

                     

                                        具状人             

                                                  

 

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