Vehicle Accident Report Form Template
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Vehicle Accident Report Form
Please provide the required information regarding the vehicular accident.
Accident Details
Date and Time of Accident
Location of Accident
Weather Conditions
Clear
Rainy
Snowy
Foggy
Windy
Road Conditions
Dry
Wet
Type of Accident
Rear-End Collision
Side Impact
Head-On Collision
Hit and Run
No. of Vehicles
No. of Persons Involved
Description of Accident
Was law enforcement notified?
Vehicle and Owner Information
Vehicle 1
Owner
Gender
Male
Female
Address
Driver's License No.
Vehicle Make and Model
License Plate No.
Insurance Company
Policy No.
Vehicle Damage Description
Is the vehicle owner injured?
If yes, please provide details
Does the vehicle have passengers?
No. of Passengers
Vehicle 1 Passenger Details
List down the names and specify if the passengers were injured or not.
No. | Name | Yes | No | Description of Injury |
|---|---|---|---|---|
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 |
Vehicle 2
Owner
Gender
Male
Female
Address
Driver's License No.
Vehicle Make and Model
License Plate No.
Insurance Company
Policy No.
Vehicle Damage Description
Is the vehicle owner injured?
If yes, please provide details
Does the vehicle have passengers?
No. of Passengers
Vehicle 2 Passenger Details
List down the names and specify if the passengers were injured or not.
No. | Name | Yes | No | Description of Injury |
|---|---|---|---|---|
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 |
Witness Information
Witness 1
Name
Phone number
Alternative Phone number
Witness 2
Name
Phone number
Alternative Phone number
Reporting Party Information
Date and Time of Report
Name
Phone number
Name:
Date:
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