In the event of an accident

In the event of an accident, it is understandable that you will be nervous and may forget to obtain certain information you will need from the other driver. It is important to stay calm, call 911, and if you are injured do not hesitate to go to the nearest emergency room. The information provided below is needed to report a claim to your insurance carrier.


Name of vehicle operator:

Name of vehicle owner (See Registration):

Address / Tel #:


Make of vehicle / Plate #

License Number:

Location of collision:

Police present:

Insurance Information:

Insurance Carrier:

Policy Number:

**Make sure to insist on seeing the other Drivers’ Registration Certificate and Operators’ License.

***If the other operator refuses to produce these documents – Call the police immediately!