Vehicle Accident Form
Your Details
Date of Accident
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Time of Accident
*
Location the Accident Occurred
Sketch of the scene
Clear drawing
Was there anyone else in your vehicle at the time?
Yes
No
Passenger Details
List any injuries and who sustained the injury
Was the accident reported to Police?
Yes
No
What is the Police Report Number?
Other Drivers Details
Name of other driver involved in accident
Drivers Licence Number
Contact Details
Address
Rego Details
Make, Model and Colour of Vehicle
Insurance Details
Where there any Witnesses?
Yes
No
Name and Contact information of all Witnesses
Who do you believe is at fault?
Yourself
Other driver
Unsure
Did each party agree to this?
Yes
No
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Additional comments or information
Sign that the information you have provided is true and correct at the time of accident
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Type signature
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