IMPORTANT THINGS TO REMEMBER

IMPORTANT THINGS TO REMEMBER

• Use this form to record accident information while the incident is still fresh in your memory; include names, addresses, insurance information of all persons and vehicles involved in the accident. • Warn oncoming traffic by turning on your auto hazard lights and setting out safety flare(s) or warning triangle(s). • Try to keep calm. • Check for injuries and get help if needed. • Do not leave the scene of an accident. • Do not admit responsibility at the accident scene or blame anyone else. • Do not discuss the scope of your insurance coverage. • Report all losses to us or your agent immediately.

• Use this form to record accident information while the incident is still fresh in your memory; include names, addresses, insurance information of all persons and vehicles involved in the accident. • Warn oncoming traffic by turning on your auto hazard lights and setting out safety flare(s) or warning triangle(s). • Try to keep calm. • Check for injuries and get help if needed. • Do not leave the scene of an accident. • Do not admit responsibility at the accident scene or blame anyone else. • Do not discuss the scope of your insurance coverage. • Report all losses to us or your agent immediately.

Indicate what happened in the diagram:

Indicate what happened in the diagram:



Vehicle #1 - Your Vehicle

Date

Time

AM / PM

Vehicle #1 - Your Vehicle

Date

Time

AM / PM

Location City State

Location City State

Approximate speed at time of accident: Vehicle #1

Approximate speed at time of accident: Vehicle #1





Vehicle #2

Vehicle #2





Vehicle #2

Vehicle #2

Driver

Driver

Address City State

Address City State

Age

Age



Sex





License Plate #



Sex





License Plate #

Make of Vehicle Color Year

Make of Vehicle Color Year

Owner

Owner

Address City State

Address City State

Insurance Company

Insurance Company

Visibly Injured?

Visibly Injured?





Injury



Vehicle #3



Injury

Vehicle #3

Driver

Driver

Address City State

Address City State

Age

Age



Sex





License Plate #



Sex





License Plate #

Make of Vehicle Color Year

Make of Vehicle Color Year

Owner

Owner

Address City State

Address City State

Insurance Company

Insurance Company

Visibly Injured?

Visibly Injured?



Injury



Police Information



Officer



Police Station







Badge #









Injury



Police Information



Officer



Police Station







Badge #

Witness

Witness

Witness

Witness

Name

Name

Name

Name







Address Address

Address Address

City State

City State

City State

City State

Phone

Phone

Phone

Phone

important things to remember important things to ...

State. Phone. Witness. Name. Address. City. State. Phone. Police Information. Officer. Badge #. Police Station. Police Information. Officer. Badge #. Police Station. Vehicle #1 - Your Vehicle. Date. Time. AM / PM. Location. City. State. Approximate speed at time of accident: Vehicle #1. Vehicle #2. Vehicle #2. Driver. Address.

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