Pericia Dpvat Modelo
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Rodrigo JimenezCREFITO 122314
Cascavel, ______ de ____________________ de 20____.
Declaro para os devidos fins que o (a)
Sr(a)___________________________________________, sofreu um acidente de trânsito
na data de _______/_______/_______sendo atendido (a)no________
_____________________________________________________________________________________
__,
apresentand
o____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________________________________
Sendo realizado
tratamento______________________________________________________________
_____________________________________________________________________________________
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____
O (A) periciado(a) segue com limitações e reduções funcionais (Dor,
FM, ADM):___________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Rua General Osório, n° 2567, Ciro Nardi, Cascavel - PR
Rodrigo JimenezCREFITO 122314
_____________________________________________________________________________________
______________________
__________________________Rodrigo Jimenez
CREFITO 122314
Rua General Osório, n° 2567, Ciro Nardi, Cascavel - PR