Auto Accident Report

Complete immediately after any vehicle accident — Travelers reporting guide.

Travelers auto accident reporting guide also availableDownload Travelers Guide (PDF)

Incident Details

Date of Accident *

Time of Accident

Road / Weather Conditions

Location of Accident *

Your Vehicle

Make

Model

Year

Color

License Plate

State

VIN

Vehicle Owner Name

Owner Address

Owner Phone

Insurance Company

Policy Number

Your Driver Information

Driver Name

Driver Address

Driver Phone

Driver License Number

License State

Other Vehicle

Make

Model

Year

Color

License Plate

State

VIN

Vehicle Owner Name

Owner Address

Owner Phone

Insurance Company

Policy Number

Other Driver Information

Driver Name

Driver Address

Driver Phone

Driver License Number

License State

Injuries

Were there injuries? *

Was an ambulance called?

Injured Parties (name, description of injury)

Police Information

Did police respond?

Police Department

Police Report Number

Officer Name / Badge #

Was a citation issued?

Citation Details

Witnesses

Witness 1 — Name

Witness 1 — Phone

Witness 1 — Address

Witness 2 — Name

Witness 2 — Phone

Witness 2 — Address

Description of Accident

Describe how the accident occurred *

Describe vehicle damage

Was towing required?

Towing Company Name & Phone

Submitted By

Your Name *

Your Job Title

Your Phone *

Your Email