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General Info

ID Number

Province

Date of Birth

Time of Day

Vehicle Registration Number

Vehicle Colour

Vehicle Make

Vehicle Model

Vehicle Type

City Location

Name of City/Town

Name of Suburb

Location of Street

Street Number (N,M,R)

Name of Street (A)

Between Street (B)

And Street (C)

Street Number (N,M,R)

Name of Street (A)

Name of Street (B)

Number of Street (A)

Inter City Location

Road/Route Number (N,M,R)

City/Interchange (A)

City/Interchange (B)

km from City/Interchange (A)

km from City/Interchange (B)

Number of Road 1 (N,M,R)

City/Interchange (A)

km from City/Interchange (A)

Number of Road 2 (N,M,R)

City/Interchange (B)

km from City/Interchange (B)

Additional Location Information

Type of Offence

Other and/or Brief Explanation