Fillable Auto Accident Report Record printable pdf download

AHTKY INSURANCE AGENCY, LLC.

AUTO ACCIDENT REPORT RECORD

Please read carefully and be sure to keep this form in the glove compartment of your vehicle. If you

are involved in an accident, it is very important that you complete the backside of this form.

Remember – stay calm and take down all details of the accident

1. Check for Injuries

5. Protect Yourself

we will forward the report to

Check everyone involved to

Do not apologize for the

your insurance company’s

see if there are injuries.

accident or admit guilt to

claims department. Your

Move out of traffic to safety.

anyone, no matter who is “At

insurance company will then

Call 911 or have someone

Fault”. If there is an

assign an adjuster who will

else call 911 if there are

individual at the scene of the

thoroughly investigate the

injuries.

accident who can be an eye

accident in order to settle

witness, be sure to obtain

the claim.

the person’s name, address

2. Accident & Scene

Pull to the side of the road (if

and phone number.

9. Complete SR-1 Form

possible). Warn passing

In California, if an accident

drivers of the accident by

6. Accident Facts

involves bodily injury, death

using triangles, flares, cones

It is very important for the

or more than $750 property

or any other safety devices

insurance company to

damage (regardless of who

in your vehicle. Watch for

determine who is “At Fault”.

is “At Fault”), a SR-1 form is

any gasoline leaks – clear

Write down the description

required by the Department

the area if gasoline is

of the accident, date, time

of Motor Vehicles (DMV).

leaking. Stay off the street.

and location of accident,

The SR-1 must be filed

speed of the vehicle(s)

within 10 days from the

involved, road conditions, if

accident date and is

3. Alert the Police

Call the police or ask a

there were stop lights or

certification that you were

passenger to do it. Only

stop signs, etc. Use the

insured at the time of the

provide detailed information

back of this form to record

accident. You may get the

that you know. Retain the

all accident details.

SR-1 form from the DMV or

police report number if a

AHTKY’s office located at:

report is made.

7. Take your Car to the

Body Shop

1451 W. Artesia Blvd.,

4. Exchange Information

If you are unable to drive

suite A

Whether the accident is “At

your vehicle to a body shop,

Gardena, CA 90248

Fault” or “Not At Fault”

please call a tow company

Phone: (310) 516-0110

exchange information with

for assistance. Do not

Fax:

(310) 516-0381

the other driver(s) involved.

repair your car until you

Obtain the other driver’s

have contacted your agent

Our office hours are 9:00

or AHTKY Insurance

name, address, phone

a.m. to 5:00 p.m., Monday

Agency to discuss this

number, drivers license

through Friday. There is a

number, insurance company

matter.

24-hour answering service

name, year, make and

for your convenience if you

model of other vehicle(s),

8. Contact AHTKY

wish to leave a message.

vehicle I.D. #, and license

Insurance Agency

Your call will be returned as

plate number. You should

Immediately

soon as possible.

provide the same

Please contact our office as

information to the other

soon as possible. When we

driver(s).

receive your accident report,

10/17/2014

Auto Accident Report Record

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