Draw a diagram of the accident showing the direction of both cars and the point of collision. Show street names and location of street signs (stop signs, etc.) Describe any other damage or pertinent details below:
In Case Of an Accident, Record This Important Information:
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Your Insurance Company |
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Other Driver’s Name, Address, Phone |
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Your Policy No |
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Type of Vehicle |
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Your Agent |
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License Plate No. |
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Date of Accident |
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Driver’s License No. (include state of issue) |
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Time of Accident |
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Insurance Company |
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Location of Accident (draw diagram) |
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Insurance Company Agent |
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Witness Name(s), Address & Phone |
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Insurance Policy No. |
