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If your involved in a road traffic accident, then please follow these instructions after firstly making sure there are no serious injuries relating to the incident.
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• Make sure everyone involved are ok
• Call your line manager Steve Jennings 07811 103520 immediately
• Do not leave the scene until confirmed with your line manager -
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Conducted on
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Vehicle Registration
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Location
Driver Information
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You will need to gather the following evidence for insurance purposes
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What to do in the event of an accident, fire or theft claim
1. Gather the details of any other party or parties involved (if applicable) including their name, address, vehicle registration number, vehicle make and model, insurance company and contact telephone number. Take photo of vehicle registration
2. Take photographs of any damage to Your vehicle and the third-parties’ vehicles, if it is safe for You to do so.
3. Take a video of the road and area leading up to and including the spot of the accident and any damage to Your vehicle and the third-parties’ vehicles, if it is safe for You to do so. Drawing of road layout and showing car direction and location and incident
4. Record the number of passengers in the third-party vehicles.
5. Record any injuries sustained to anyone involved in the accident.
6. Gather the details of any witnesses at the scene of the accident, including their name, address and contact telephone number.
7. Gather the details of any Police Officer, including their name, collar number, and contact telephone number. -
Complete Driver Information
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Name of Driver or last person in charge of the Vehicle
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Home Address
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Date of Birth
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Contact Number
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Have you any Motoring convictions?
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Please include offence code, conviction date, fine and points
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Have you any Pending motoring prosecutions?
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Include date of alleged offence, nature of charges and hearing date if known
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Have you ever been refused motor insurance?
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Give details of refused insurance or declined claim
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Do you suffer from any medical disabilities?
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Please discribe nature of any medical conditions or disabilities together with date of diagnosis and any medication
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Have you been advised not to drive by any Doctor or Medical professional?
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Type of Driving licence held:
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Year Licence Issued:
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State class of HGV licence held:
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Did the driver suffer injury in this incident?
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Nature of Injury
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Did an Ambulance attend the scene
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Was the Driver transferred to Hospital
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Complete Vehicle Details
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Registration Number
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Make and Model
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Mileage
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Year of Reg:
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State purpose for which the vehicle was being used
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Number of Passengers in your vehicle
- 0
- 1
- 2
- 3
- 4
- Other
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State number of Pasengers
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Complete Details of Incident
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Type of Incident
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Date
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Incident location
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Photos of the Location showing Vehicles
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Weather conditions
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Road Conditions
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Speed Limit
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Type Of Road
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Your Speed MPH
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Other Vehicles speed MPH
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Did the Police attend?
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Incident/ Crime Reference
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Name and Number of reporting Officer
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Name of Constabulary
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Area of Damage
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Severity of Damage?
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Photos of the damage. (Take photos close up and standing back)
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Incident Description (Write out statement and take photo or scan)
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Who do you consider to blame and why?
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Sketch (Draw out incident and take photo or scan)
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Precautions taken to prevent Theft
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Has the Thief been apprehended?
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State incident
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Complete Other Parties Involved
OTHER PARTIES INVOLVED
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Complete Other Parties Involved
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Other Parties Name
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Other Parties Address
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Other Parties Contact Number
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Insurers Name and Address
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Insurers telephone number
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Policy/Ref No:
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Registration of other parties vehicle
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Other Parties Name
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Other Parties Address
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Other Parties Contact Number
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Insurers Name and Address
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Insurers telephone number
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Policy/Ref No:
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Registration of other parties vehicle
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Make and Model
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Colour
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Area of Damage
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Photos of the damage. (Take photos close up and standing back)
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Severity of Damage
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Number of passengers in other vehicle
- 0
- 1
- 2
- 3
- 4
- Other
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State number of passengers
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Did anybody involved suffer injury?
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Provide full details of injuries
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Did an Ambulance attend the scene
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Was anybody transferred to Hospital?
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Complete Witness information
Witnesses
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Name
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Address
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Contact Number
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Known to Whom
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Complete Additional information
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Additional Information
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Additional Photos
