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Reporter's Info
Full Name
Email
Phone No.
Basic Information
Date of Occurance
Rout (Road)
Nearest Town
Distance from nearest town
Less than 5km
About 5km
Above than 5km
Less than 10km
Above 10km
More than 10km
Unkown
State & LGA
Type of road
Doubel Lane
Single Lane
Untarred Road
T junction
Accident Description
Casuality Information
Serverity
Low
Medium
High
Collision Type
Nature of injuries substained
Other Informations
Description of vehcile
Hospital refered to
Health status of victimes
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