File: /var/www/html/taxicamera/pmw_live_testing/old/application/views/admin/setting/accident_pdf.php
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<title>EC Legal Claim Form</title>
<style type="">
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<div class="body_wrapper" style="border: 1px solid #ccc;padding: 20px;width:750px;margin: 40px auto;">
<div class="pdf_header clear">
<div class="head_box1 h_box1" style="text-align:left;">
<!-- <img src="<?//= base_url('./images/logo.jpg') ?>" alt="" /> -->
<img src="./images/logo.jpg" alt="" />
</div>
<div class="head_box1 h_box2" style="text-align:right;">
<p style="color:#000;font-size: 12px;font-weight: normal;margin: 0 0 2px;">E C Legal Pty Ltd ABN 20 050 271 684</p>
<p style="color:#000;font-size: 12px;font-weight: normal;margin: 0 0 2px;">Level 9, 461 Bourke Street, Melbourne VIC 3000</p>
<p style="color:#000;font-size: 12px;font-weight: normal;margin: 0 0 2px;">Tel: 03 8611 2699 | Email: info@eclegal.com.au</p>
<a href="<?php echo base_url();?>images/logo.jpg" style="color:#6aaab8;text-decoration: none;font-size: 11px;font-weight: normal;margin: 0;">www.eclegal.com.au</a>
</div>
</div>
<div class="page_title_area clear">
<h2 style="color:#000;font-size: 28px;font-weight: normal;margin: 20px 0 10px 0;text-align: center;">Motor Vehicle Claim Instructions</h2>
</div>
<?php if(isset($owner_vehicle) && $owner_vehicle):?>
<div class="form_bg clear" style="margin-top:15px; background: #eeeeef;padding: 15px;width: 100%;display:block;margin: 10px 0 0;">
<h2 style="color:#6aaab8;font-size: 21px;font-weight: normal;margin: 0 0 20px;">Your Vehicle Details:</h2>
<div class="col_2_box">
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Make:</span> <span class="f_input"><?= $owner_vehicle['company_make'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Rego:</span> <span class="f_input"><?= $owner_vehicle['company_rego'];?></span></p>
</div>
</div>
</div>
<div class="col_1_box">
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Owner Name:</span> <span class=""><?= $owner_vehicle['company_name'];?></span> </p>
</div>
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Owner Address:</span> <span class=""><?= $owner_vehicle['companyaddress'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Owner Contact:</span> <span class="f_input">Home/Work:</span><span class=""><?= $owner_vehicle['company_landline'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Mobile:</span> <span class=""><?= $owner_vehicle['company_mobile'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Email:</span> <span class=""><?= $owner_vehicle['company_email'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">ABN:</span> <span class=""><?= $owner_vehicle['company_abn'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Driver Name:</span> <span class=""><?= $owner_vehicle['drivername'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Driver Address:</span> <span class=""> <?= $owner_vehicle['driveraddress'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Date of Birth:</span> <span class=""><?= $owner_vehicle['driverdob'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">
License & Expiry Date::</span> <span class=""> <?= date('d/m/Y', strtotime($owner_vehicle['driver_dr_licence_expiry']));?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Driver Contact:</span> <span class=""><?= $owner_vehicle['driverlandline'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Mobile:</span> <span class=""><?= $owner_vehicle['drivermobile'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Email</span> <span class=""><?= $owner_vehicle['driveremail'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label"></span> <span class="f_input"></span></p>
</div>
</div>
</div>
</div>
<?php endif ?>
<?php if(isset($singl_accidents) && $singl_accidents):?>
<?php $i=1;?>
<?php foreach($singl_accidents as $key =>$singl_accident):?>
<div class="form_bg clear" style="margin-top:15px; background: #eeeeef;padding: 15px;width: 100%;display:block;margin: 10px 0 0;">
<h2 style="color:#6aaab8;font-size: 21px;font-weight: normal;margin: 0 0 20px;">Offending Vehicle Details:<!-- Your Vehicle Details: --></h2>
<div class="col_2_box">
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">No. of cars involved in accident:</span> <span class="f_input"><?= $no_of_car_invol + 1 ;?></span> </p>
</div>
<div class="col_2">
</div>
</div>
<?php if($no_of_car_invol > 1){?>
<h4 class="form-section">Car No:<?php echo $i;?></h4>
<?php } ?>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Make:</span> <span class="f_input"><?= $singl_accident['make'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Rego:</span> <span class="f_input"><?= $singl_accident['rego'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Insured:</span> <span class="">
<?php if($singl_accident['is_insured']==1){
echo "Yes";
}else if($singl_accident['is_insured']==2){
echo "No";
} ?>
</span></p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal; "><span class=""></span> <span class="f_input"></span> </p>
</div>
</div>
<div class="col_repeat">
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal; "><span class="f_label">If Yes, name of Insurer & Claim/Policy number:</span> <span class="f_input"><?= $singl_accident['insurance_company'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal; "><span class=""> </span> <span class="f_input"></span> </p>
</div>
</div>
</div>
<div class="col_1_box">
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Owner Name:</span> <span class=""><?= $singl_accident['owner_name'];?></span> </p>
</div>
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Owner Address:</span> <span class=""><?= $singl_accident['owner_address'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Owner Contact:</span> <span class="f_input">Home/Work:</span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Mobile:</span> <span class=""><?= $singl_accident['owner_contact_no'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Email:</span> <span class=""><?= $singl_accident['owner_email'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label"> </span> <span class=""></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Driver Name:</span> <span class=""><?= $singl_accident['driver_name'];?></span> </p>
</div>
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label">Driver Address:</span> <span class=""> <?= $singl_accident['driver_address'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Driver Contact:</span> <span class=""><?= $singl_accident['driver_contact_no'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Mobile:</span> <span class=""><?= $singl_accident['driver_contact_no'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Email:</span> <span class=""><?= $singl_accident['driver_email'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label"></span> <span class=""></span></p>
</div>
</div>
</div>
</div>
<?php $i++; ?>
<?php endforeach ?>
<?php endif ?>
<div class="form_bg clear" style="margin-top:15px; background: #eeeeef;padding: 15px;width: 100%;display:block;margin: 10px 0 0;">
<h2 style="color:#6aaab8;font-size: 21px;font-weight: normal;margin: 0 0 20px;">Witness Details:</h2>
<div class="col_1_box">
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label"> Name:</span> <span class=""><?= $singl_accident['witness_name'];?></span> </p>
</div>
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label"> Address:</span> <span class=""><?= $singl_accident['witness_address'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Contact:</span> <span class="f_input">Home/Work:</span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Mobile:</span> <span class=""><?= $singl_accident['witness_mobile'];?></span></p>
</div>
</div>
</div>
</div>
<div class="form_bg clear" style="margin-top:15px; background: #eeeeef;padding: 15px;width: 100%;display:block;margin: 10px 0 0;">
<h2 style="color:#6aaab8;font-size: 21px;font-weight: normal;margin: 0 0 20px;">Accident Details:</h2>
<div class="col_1_box">
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Date & Time:</span> <span class=""><?= date('d/m/Y h:i A', strtotime($singl_accident['accident_datetime']));?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Place:</span> <span class=""><?= $singl_accident['place'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_1">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 15px 0;"><span class="f_label"> Description:</span> <span class=""><?= $singl_accident['witness_mobile'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal; "><span class="f_label">Police: Was police attended?</span> <span class="">
<?php if($singl_accident['is_police_attended']==1){
echo "Attended";
}else{
echo "Not Attended";
} ?>
</span> </p>
</div>
</div>
<div class="col_repeat">
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal; "><span class=""> </span> <span class="f_input"></span> </p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Police Station:</span> <span class=""><?= $singl_accident['police_station'];?></span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Name of the police officer:</span> <span class=""><?= $singl_accident['officer_name'];?></span></p>
</div>
</div>
<div class="col_repeat">
<div class="col_2 ">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Contact:</span> <span class="f_input">Home/Work:</span> </p>
</div>
<div class="col_2">
<p style="color:#000;font-size: 14px;font-weight: normal;"><span class="f_label">Mobile:</span> <span class=""><?= $singl_accident['officer_phone_no'];?></span></p>
</div>
</div>
</div>
</div>
<div style="background: #eeeeef;padding: 15px;width: 100%;display:block;margin: 10px 0 0;box-sizing: border-box;">
<h2 style="color:#6aaab8;font-size: 21px;font-weight: normal;margin: 0 0 20px;">Diagram of Accident:</h2>
<div style="width: 15%; display: inline-block;">
<div style="width: 100%; display: block;margin: 0 0 20px;">
<img src="./images/diagram1.jpg" alt="" />
<p style="margin: 0;">Your Vehicle</p>
</div>
<div style="width: 100%;display: block;margin: 0 0 20px;">
<img src="./images/diagram2.jpg" alt="" />
<p style="margin: 0;">Other Vehicle</p>
</div>
<div style="width: 100%;display: block;margin: 0 0 20px;">
<img src="./images/diagram3.jpg" alt="" />
<p style="margin: 0;">Stop Sign</p>
</div>
<div style="width: 100%;display: block;">
<img src="./images/diagram4.jpg" alt="" />
<p style="margin: 0;">Give Way Sign</p>
</div>
</div>
<div style="width: 50%;display: inline-block; background: #fff;border:1px solid #000;height: 400px;"></div>
<div style="width: 31%;display: inline-block;margin-left: 20px;">
<img src="./images/diagram-right.jpg" alt="big diagram" />
<p style="margin: 0;">Shade damaged areas of your vehicle</p>
</div>
</div>
<!-- static_txt_area -->
<div class="static_txt_area" style="padding:10px; margin-top:10px;">
<h2 style="text-align: center;text-transform: uppercase;color:#000;font-size: 18px;margin: 0 0 20px;">WHAT YOU SHOULD DO</h2>
<p>1. Before you sign this form, read the information on our website at www.eclegal.com.au especially the Client Information Section under Motor Vehicle Collision
Recovery. Contact us if you have any questions;</p>
<p>2. Complete the details on this form fully and truthfully. Provide as much information as possible;</p>
<p>3. Sign and return the form to us. Our address is on the first page;</p>
<p>4. Be prepared to provide us with a copy of the vehicle registration certificate and any other information about the collision</p>
<p>5. If you are comprehensively insured, lodge a claim form with your insurer marked “Report Only”. This will protect your rights and will not affect your no claim
bonus if a claim is not made;</p>
<p>6. Refer any communications from the offending party or their insurers to us. Do not communicate directly with these people.</p>
<div style="width: 100%;display:block;margin-bottom: 5px;">
<h2 style="text-align: center;text-transform: uppercase;color:#000;font-size: 18px;margin: 0 0 20px;">WHAT WE WILL DO</h2>
<p>1. Ensure that your vehicle is assessed by qualified assessors. There is no need for you to obtain any further quotes;</p>
<p>2. Make a claim on the offending party or their insurers. Upon recovery of funds, we will pay the repairer directly for the repair cost;</p>
<p>3. All costs and charges will be paid by the offending party or their insurance company. The repairer will also contribute to these costs and charges. <strong>There will be
no cost to you except in circumstances set out on www.eclegal.com.au</strong> – these include unless you deal directly with the offending party or their insurance
company; withdraw your claim after 7 days of us contacting you to confirm these instructions or decide not to authorise the repairer to repair the vehicle.</p>
</div>
<div style="width: 100%;display:block;margin-bottom: 5px;">
<h2 style="color:#fff;text-align: center;line-height: 35px;font-size: 18px;margin: 0 0 20px;background: #6aa8ba">Repairer Confirmation</h2>
<div class="sign_area">
<div class="s_box sign_left">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 0px 0;"><span class="">(name of panel shop)</span> <span class="">___________________</span> </p>
</div>
<div class="s_box sign_right">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 0px 0;">confirms that this matter is referred to E C Legal on the basis set out on our website at <b>www.eclegal.com.au</b> under Motor Vehicle Collision Recovery – Repairer Information.</p>
</div>
</div>
<div class="sign_area">
<div class="s_box sign_left">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 0px 0;"><span class="">Dated:</span> <span class="">___________________</span> </p>
</div>
<div class="s_box sign_right">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 0px 0;"><span class="">Signature of Repairer:</span> <span class="">___________________</span> </p>
</div>
</div>
<div style="clear: both"></div>
</div>
<div style="width: 100%;display:block;margin-top: 15px;margin-bottom: 5px;">
<h2 style="color:#fff;text-align: center;line-height: 35px;font-size: 18px;margin: 0 0 20px;background: #6aa8ba">Authority To Act</h2>
<p>I / We instruct E C Legal to act on my / our behalf to recover the losses arising from the collision as set out on this form.</p>
<p>I / We authorise E C Legal to:</p>
<ul style="margin: 0;padding: 0 0 20px 15px;">
<li>do all things necessary for the conduct of the recovery action including settling the claim provided that the settlement covers all the costs arising from the collision and I have no further liability to any person;</li>
<li>negotiate an agreeable cost of repairs directly with my referring repairer to enable a settlement to occur;</li>
<li>commence legal proceedings (following any necessary advice from E C Legal) provided that my referring repairer and E C Legal are responsible for all costs incurred;</li>
<li>pay your referring repairer and any other service providers (e.g. assessor, rental vehicle provider) directly for any expenses properly incurred</li>
</ul>
<div style="clear: both"></div>
</div>
<div class="sign_area">
<div class="s_box sign_left">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 0px 0;"><span class="">Dated:</span> <span class="">___________________</span> </p>
</div>
<div class="s_box sign_right">
<p style="color:#000;font-size: 14px;font-weight: normal;margin: 0 0 0px 0;"><span class="">Signature of Repairer:</span> <span class="">___________________</span> </p>
</div>
</div>
</div>
</div>
</body>
</html>