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What to do in case of an accident
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This information is provided as a courtesy of AAA Insurance.

Accident Checklist

  • Stop immediately. Keep calm. Do not argue, accuse anyone, or make any admission of blame for the accident. Do not leave the scene, however, if the vehicles are operable, move them to the shoulder of the road and out of the way of oncoming traffic.
  • Warn oncoming traffic.
  • Call medical assistance for anyone injured. Do what you can to provide first aid, but do not move them unless you know what you are doing.
  • Call appropriate law enforcement authorities.
  • Get information requested in this form.

Your Vehicle Information

Owner: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

________________________________________________

Make/Model: _____________________________________

Vehicle ID: _______________________________________

License Plate #: ___________________________________

State License Issued: _______________________________

Driver's Name: ____________________________________

Phone: (________)_________________________________

Address: _________________________________________

_________________________________________________

Driver's License # ___________________________________

State License Issued: ________________________________

Area of Damage: ____________________________________


Other Vehicle

Owner: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

________________________________________________

Make/Model: _____________________________________

Vehicle ID: _______________________________________

License Plate #: ___________________________________

State License Issued: _______________________________

Driver's Name: ____________________________________

Phone: (________)_________________________________

Address: _________________________________________

_________________________________________________

Driver's License # ___________________________________

State License Issued: ________________________________

Area of Damage: ____________________________________


Injured Person

Name: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

_________________________________________________

Age: _____________________________________________

Extent of Injury: ____________________________________


Damage to Other Property

Owner: __________________________________________

Phone: (________)_________________________________

Address: _________________________________________

________________________________________________

Nature of Damage: _________________________________

________________________________________________


Accident Facts

Date: ___________________________________________

Time: ___________________________________________

City: ____________________________________________

Street: __________________________________________

Condition of Road: _________________________________

Weather: _________________________________________

Direction of your car: ________________________________

Speed of your car: __________________________________

Direction of other car: ________________________________

Speed of other car: __________________________________

Did the police take a report?: ___________________________

Responding police department: _________________________

Case / Report Number: ________________________________

Please give a brief description of how the accident occurred:

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________


Witnesses

Name: _____________________________________________

Phone: (________)____________________________________

Address: ____________________________________________

___________________________________________________


Name: _____________________________________________

Phone: (________)____________________________________

Address: ____________________________________________

___________________________________________________


If you are insured with AAA Insurance (Automobile Club Inter-Insurance Exchange / Auto Club Family Insurance Company)

Immediately report any accidents to us. If you are not the owner of the car you were driving at the time of the accident, report the accident to both your insurance company and to the owner's insurance company. If you are driving a company owned business vehicle, report the accident promptly in accordance with your company's instructions. Make prompt written report to authorities as required by law.

Please contact AAA Insurance Claims to report a loss:

 

By Phone - OR - Online
1-800-222-7623, Ext. 5000 Access claims forms.

Automobile Club Inter-Insurance Exchange
Auto Club Family Insurance Company
P.O. Box 66502
St. Louis, MO 63166

 

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If you are insured with AAA Insurance (Automobile Club Inter-Insurance Exchange / Auto Club Family Insurance Company)
Immediately report any accidents to us. If you are not the owner of the car you were driving at the time of the accident, report the accident to both your insurance company and to the owner's insurance company. If you are driving a company owned business vehicle, report the accident promptly in accordance with your company's instructions. Make prompt written report to authorities as required by law.
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