# Conn. Practice Book Form 201: Form 201 > Connecticut · Court rules · In force URL: https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R201 ## Section - **Citation:** Conn. Practice Book Form 201 - **Heading:** Form 201 - **Jurisdiction:** Connecticut - **Kind:** Court rules - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Connecticut Court Rules / Connecticut Practice Book Appendix of Forms / Conn. Practice Book Form 201 ## Text (9) State whether any insurer, as described in Interrogatories #7 and #8 above, has disclaimed/ reserved its duty to indemnify any insured or any other person protected by said policy. (10) If applicable, describe in detail the damage to your vehicle. (11) If applicable, please state the name and address of an appraiser or firm which appraised or repaired the damage to the vehicle owned or operated by you. (12) If any of the Defendants are deceased, please state the date and place of death, whether an estate has been created, and the name and address of the legal representative thereof. (13) If any of the Defendants is a business entity that has changed its name or status as a business entity (whether by dissolution, merger, acquisition, name change, or in any other manner) since the date of the incident alleged in the Complaint, please identify such Defendant, state the date of the change, and describe the change. (14) If you were the operator of any motor vehicle involved in the incident that is the subject of this action, please state whether, at the time of the incident, you were operating that vehicle in the course of your employment with any person or legal entity not named as a party to this lawsuit, and, if so, state the full name and address of that person or entity. (15) If you were the operator of any motor vehicle involved in the incident that is the subject of this action, please state whether you consumed or used any alcoholic beverages, drugs or medications within the eight (8) hours next preceding the time of the incident alleged in the Complaint and, if so, indicate what you consumed or used, how much you consumed, and when. (16) Please state whether, within eight (8) hours after the incident alleged in the Complaint, any testing was performed to determine the presence of alcohol, drugs or other medications in your blood, and, if so, state: (a) the name and address of the hospital, person or entity performing such test or screen; (b) the date and time; dicate what you consumed or used, how much you consumed, and when. (16) Please state whether, within eight (8) hours after the incident alleged in the Complaint, any testing was performed to determine the presence of alcohol, drugs or other medications in your blood, and, if so, state: (a) the name and address of the hospital, person or entity performing such test or screen; (b) the date and time; (c) the results. (17) Please identify surveillance material discoverable under Practice Book Section 13-3 (c), by stating the name and address of any person who obtained or prepared any and all recordings by film, photograph, video, audio or any other digital or electronic means, of any party concerning this lawsuit or its subject matter, including any transcript thereof which are in your possession or control or in the possession or control of your attorney, and state the date on which each such recordings were obtained and the person or persons of whom each such recording was made. (18) If you were the operator of any motor vehicle involved in the incident that is the subject of this action, please state whether you were using a cell phone for any activity including, but not limited to, calling, texting, emailing, posting, tweeting, or visiting sites on the Internet for any purpose, at or immediately prior to the time of the incident. PLAINTIFF, BY ## Nearby sections - [Conn. Practice Book Form 101 Form 101. Heading of Pleadings, Motions and Requests](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R101.md) - [Conn. Practice Book Form 201 Form 201](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R201.md) - [Conn. Practice Book Form 202 Form 202](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R202.md) - [Conn. Practice Book Form 203 Form 203](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R203.md) - [Conn. Practice Book Form 204 Form 204. Plaintiff’s Requests for Production](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R204.md) - [Conn. Practice Book Form 205 Form 205. Defendant’s Requests for Production](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R205.md) - [Conn. Practice Book Form 206 Form 206. Plaintiff’s Requests for Production—Premises Liability](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R206.md) - [Conn. Practice Book Form 207 Form 207](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R207.md) - [Conn. Practice Book Form 208 Form 208. Defendant’s Supplemental Interrogatories—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R208.md) - [Conn. Practice Book Form 209 Form 209. Defendant’s Supplemental Requests for Production—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R209.md) - [Conn. Practice Book Form 210 Form 210. Defendant’s Interrogatories—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R210.md) - [Conn. Practice Book Form 211 Form 211. Defendant’s Requests for Production—](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R211.md) - [Conn. Practice Book Form 212 Form 212. Defendant’s Interrogatories—Loss of Consortium](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R212.md) - [Conn. Practice Book Form 213 Form 213](https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R213.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/SRULES_CT_FORMS_R201. Check the current official text before relying on it. Not legal advice.