AAA Auto Insurance by jianglifang

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									What to do in case of an accident

Accident Checklist


      Stop immediately. Keep calm. Do not argue, accuse anyone, or make any admission of blame for the
      accident. Do not leave the scene, however, if the vehicles are operable, move them to the shoulder of the
      road and out of the way of oncoming traffic.
      Warn oncoming traffic.
      Call medical assistance for anyone injured. Do what you can to provide first aid, but do not move them
      unless you know what you are doing.
      Call appropriate law enforcement authorities.
      Get information requested in this form.



Your Vehicle Information

Owner: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

________________________________________________

Make/Model: _____________________________________

Vehicle ID: _______________________________________

License Plate #: ___________________________________

State License Issued: _______________________________

Driver's Name: ____________________________________

Phone: (________)_________________________________

Address: _________________________________________

_________________________________________________

Driver's License # ___________________________________

State License Issued: ________________________________

Area of Damage: ____________________________________

Other Vehicle

Owner: __________________________________________

Phone: (________)_________________________________
Address: _________________________________________

________________________________________________

Make/Model: _____________________________________

Vehicle ID: _______________________________________

License Plate #: ___________________________________

State License Issued: _______________________________

Driver's Name: ____________________________________

Phone: (________)_________________________________

Address: _________________________________________

_________________________________________________

Driver's License # ___________________________________

State License Issued: ________________________________

Area of Damage: ____________________________________

Injured Person

Name: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

_________________________________________________

Age: _____________________________________________

Extent of Injury: ____________________________________

Damage to Other Property

Owner: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

________________________________________________

Nature of Damage: _________________________________

________________________________________________

Accident Facts

Date: ___________________________________________

Time: ___________________________________________

City: ____________________________________________
Street: __________________________________________

Condition of Road: _________________________________

Weather: _________________________________________

Direction of your car: ________________________________

Speed of your car: __________________________________

Direction of other car: ________________________________

Speed of other car: __________________________________

Did the police take a report?: ___________________________

Responding police department: _________________________

Case / Report Number: ________________________________

Please give a brief description of how the accident occurred:

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

Witnesses

Name: _____________________________________________

Phone: (________)____________________________________

Address: ____________________________________________

___________________________________________________


Name: _____________________________________________

Phone: (________)____________________________________

Address: ____________________________________________

___________________________________________________


Immediately report any accidents to your insurance company. If you are not the owner of the car
you were driving at the time of the accident, report the accident to both your insurance company
and to the owner’s insurance company. If you were driving a company owned business vehicle,
report the accident promptly in accordance with your company’s instructions. Make prompt
written report to authorities as required by law.

								
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