Your Vehicle

Today's date

Driver's name

Phone number

Vehicle’s Year/Make:

Number of passengers

Number injured

Damage to your vehicle

Insurance Company

Policy Number

Other Vehicle

Other Driver's name

Phone number

Vehicle’s Year/Make:

Number of passengers

Number injured

Damage to other vehicle

Insurance Company

Policy Number

Accident

Date

Time

Street

City

Police Dept. taking report

Report #

Witnesses

Name

Address

Name

Address

Phone

Phone

How did accident happen?

Who caused the accident?

Vehicle Insurance Fraud... How You can Stop It!

1. Report any accident you are involved in or witness.

2. Besides reporting the claim to the company, tell your insurance agent.

3. Make sure that the police are called to investigate the accident and insist on a copy of the

police report.

4. Get the ID’s of all individuals involved in the accident.

5. If something feels funny, where people want to give you money, or inflate your body shop

estimate, call your insurance company.

6. If you suspect fraud or a fraud theft scheme, notify your police department or the national

Insurance Crime Bureau, at 1-800-TELNICB. Callers are eligible for rewards of up to $1,000.