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Accident Report
(Print this out for your glove box)
Do...
* Stop and identify Yourself
* Show your driver's license and registration to the other driver, the injured persons, and to any police officer.
Don't...
* Do not discuss responsibility
* Do not discuss the circumstances of the accident with anyone except the police and a positively identified
representative of your insurance company.
My Name:___________________________ Date & Time of
Accident:_________________________
Accident Location:_____________________
Street/Hwy:___________________________________
City:_________________________________________ State:_____________
Was Anyone Injured ?_____ You / Your
Passengers:___________________
Other Party:___________________________ Others:______________________________
Police / Accident Report #:_______________ Name of Officer on the
scene:______________________
Officer's Badge # & Contact Info:__________________________________________________________
Make/Model of your Vehicle:
Make/Model of Vehicle:_____________________ Year:__________ Color:__________
No. of Passengers:_____
The Other Party Involved In the Accident:
Name:_______________________________ Address:_____________________________________
City:________________________________ State:________________________________________
Zip:_______________ Phone#:_____________________
DL#:______________________
DOB:______________________
Name of Registered Owner of Vehicle:__________________________
Insurance Co:__________________________ Policy #:______________________________
License#:______________________ State:_________________________
Other Vehicle Information:
Name:________________________________ Address:_____________________________________
City:__________________________________ State:_______________________________________
Zip:_______________ Phone#:_____________________
DL#:______________________ DOB:______________________
License #: ____________
State:_________________________
Make/Model of Vehicle:_____________________ Year:__________
Color:_________ No. of Passengers:______________
Click Here for another convenient form to
keep your information in your glove box "just in case"
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