Oklahoma Motor Vehicle Collision Report Page 2
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1
2D
P
S
EPARTMENT OF
UBLIC
AFETY
O
M
V
C
R
KLAHOMA
OTOR
EHICLE
OLLISION
EPORT
Driver Compliance Division
P.O. Box 11415
3600 N. M L King Ave
Oklahoma City OK 73136-0415
405.425.2098
Oklahoma City OK 73111
INSURANCE INFORMATION EXCHANGE
Police Officer
DATE
Use this form to exchange your information with the other party at
the scene of the collision.
Driver Name
Driver License No.
Date of Birth
Insurance Company
Phone
Address
Phone
Agent Name
City State Zip
Address
Vehicle Owner:
City State Zip
‘
same as driver
Address
Phone
Policy No.
City State Zip
Policy Effective Date
Policy Expiration Date
Driver License No.
Date of Birth
Vehicle Make
Model
Year
Tag No./State
**
The official Oklahoma Traffic Collision Report, the police investigative report, can be obtained by calling Records Management at 405.425.2262
**
INSTRUCTIONS
WHILE AT THE SCENE OF THE COLLISION
1. Print your name and insurance information legibly in the form above.
2. Give your information to the other driver and then you receive their information.
3. Contact their insurance agent and your insurance agent to report the collision and to file the proper claim forms.
If the insurance information provided above is denied or non-existent or you did not have the opportunity
to obtain the above information, you will need to complete the reverse side of this form and submit
within one year from the date of the collision.
4.
Using this form which contains the other party’s information (if investigated by law enforcement personnel), complete all
blanks; incomplete reports will be returned. Date of birth must be included for adverse driver and/or owner; your
insurance information must also be included.
5.
Report must be dated and signed.
6.
Attach the following appropriate documents as evidence of personal injury or property damage.
PERSONAL INJURY - Copies of itemized doctor, hospital, and/or pharmacy bills incurred as a result of the collision.
(a)
VEHICLE DAMAGE - An itemized estimate of repair or total loss statement for damages caused by the collision, dated and
(b)
signed by an authorized representative of a garage or body shop. Do not send any other supporting evidence such as pictures,
copies of checks, or other type of documents or diskettes.
(c)
PROPERTY DAMAGE, OTHER THAN MOTOR VEHICLE - An itemized estimate or statement of repair due to the collision
separately listing the cost of materials and the cost of labor dated and signed by a qualified professional or your receipts.
Insurance denial from other party’s company if a claim was filed.
(d)
7.
Upon completion, mail the report to the Department of Public Safety at the above address.
DPS FR307 024 012008
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