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Claims Advice: Accident Facts
 |   Auto Accident  |   Home Theft  |   Property Loss  |   Water   |   Vandalism   |   Fire and Smoke  |   FAQ  | 
Print out this guide and keep it in your glove compartment. In the event of an auto accident, record critical information while at the scene of the accident or as soon afterwards as possible..

When and Where

Date:    Time:   
City:    State:   
  My vehicle Other vehicle
Driving on what street::
In what Direction:
Signal given:
Lights on:

Speed Limit:
 
   Dry       Wet       Icy       Snowy       Muddy   
Street condition:          


Others Involved

  Driver      Passenger       Pedestrian
Name:
Phone:
Address:
City/St/Zip:
Insured with:
Policy Number:
Insurance Company
Phone:
Vehicle(year/model/type):
License plate number:


  Driver      Passenger       Pedestrian
Name:
Phone:
Address:
City/St/Zip:
Insured with:
Policy Number:
Insurance Company
Phone:
Vehicle(year/model/type):
License plate number:


Damage to My Vehicle

Exterior:

Interior:


Damage to Other Vehicle

Exterior:

Interior:




Damage to Property

(Examples: house, fence, mailbox )
Name:
Phone:
Address:
City/St/Zip:


Injuries

  Driver      Passenger       Pedestrian
Name:
Phone:
Address:
City/St/Zip:
Hospital:
Type of Injury:


  Driver      Passenger       Pedestrian
Name:
Phone:
Address:
City/St/Zip:
Hospital:
Type of Injury:
Did an ambulance come to the scene?    Yes    No
Was treament provided?                          Yes    No






Witnesses

Name:
Phone:
Address:
City/St/Zip:


Name:
Phone:
Address:
City/St/Zip:


Police Investigation

Noitified police?   Yes    No
If yes which department:
Police Report number:
Arrests or citations?    You    Other driver
Reason for citation/ticket:


Towing Service

Name:
Phone:
Address:
City/St/Zip:
Vehicle towed to:









For your Reference

Your Auto Policy number:
Your Agent's name:
Phone number:
Address:
City/St/Zip:





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