Accident-Report English

Accident Report Form
1 Date of accident
Does not constitute an admission of liability, just

a statement of identity and the circumstances.
Accidentsketch.com
2 Locality Country Place
Time
3 Injuries even if slight

no
4 Material damage
other than to vehicles A and B:
objects other than vehicles:
no
no
yes
yes
Vehicle A
Circumstances
* see insurance
certificate
6 Insured/policyholder*
Vehicle B
12
Surname
Surname
First name
explain the drawing -* delete where appropriate:
First name
Address
Address
ZIP code
Country
Tel. or e-mail
7 Vehicle
What happened?
* parked / stopped
* leaving a parking space / opening

a vehicle door
entering a parking space
*emerging from a parking space, from private

premises, from a track
*entering a parking space,

private premises, a track
entering a roundabout
circulating a roundabout
striking the rear of the other vehicle in the same

line of traffic and travelling in the same direction
going in the same direction but

in a different line of traffic
10
changing lines of traffic
10
11
overtaking
11
12
turning to the right
12
13
turning to the left
13
14
reversing
14
15
changing to a lane reserved for traffic in

the opposite direction
15
16
coming from the right (at a junction)
16
Trailer:
Motor:
Make, type
Registration No.
Registration No.
Country of registration
(see insurance certificate)
Surname
Policy No.
Insurance Certificate
valid
from
to
Agency (or bureau, or broker)

Address
Country
Tel. or e-mail
Does the policy cover material damage to the
vehicle?
no
(see driving licence)
yes
17 had not observed a priority sign or a red light 17
Surname
First name
Date of birth
13
Address
Country
Tel. or email
Driving licence No.
Category
State the number of

boxes marked with a cross
Zip code
Country
Tel. or e-mail
7 Vehicle
Trailer:
Motor:
8 Insurance company
Make, type
Registration No.
Registration No.
8 Insurance company
Surname
Policy No.
valid
from
to

Address
Country
Tel. or e-mail
vehicle?
9 Driver
no
yes
Surname
First name
Date of birth
Sketch of accident when impact occurred
Address
Complete your sketch later: www.AccidentSketch.com

Indicate 1. the layout of the road 2. by arrows the direction
of the vehicles A, B 3. their position at the time of impact
4. the road signs 5. names of the streets or roads
Country
Tel. or email
Driving licence No.
Category
Driving licence valid until:

10 Indicate the point of initial
impact to vehicle A by an
arrow

impact to vehicle B by an
arrow
Your Sketch of the accident:
11 Visible damage to
vehicle A:
14 My remarks:
* see insurance
certificate
Put a cross in each of the relevant boxes to help
9 Driver
yes
5 Witnesses: names, addresses, tel.
vehicle B:
15
Signatures of the drivers
15
14 My remarks:
AccidentSketch.com | Provided by ClaimMS GmbH | PO Box 111248 | D-57258 Freudenberg | www.Claim.MS

Infoline: +49 271 222 9 222 | eMail: Info@Claim.MS | www.Accidentsketch.com
Accident Report Form

1 Date of accident
Does not constitute an admission of liability, just

a statement of identity and the circumstances.
Accidentsketch.com
2 Locality Country Place
Time
3 Injuries even if slight

no
4 Material damage
other than to vehicles A and B:
objects other than vehicles:
no
no
yes
yes
Vehicle A
Circumstances
* see insurance
certificate
Vehicle B
12
Surname
Surname
First name
explain the drawing -* delete where appropriate:
First name
Address
Address
ZIP code
Country
Tel. or e-mail
7 Vehicle
Trailer:
Motor:
Make, type
Registration No.
Registration No.
8 Insurance company
Surname
Policy No.
valid
from
to

Address
Country
Tel. or e-mail
vehicle?
no
yes
What happened?
* parked / stopped
* leaving a parking space / opening

a vehicle door
entering a parking space
*emerging from a parking space, from private

premises, from a track
*entering a parking space,

private premises, a track
entering a roundabout
circulating a roundabout
striking the rear of the other vehicle in the same

line of traffic and travelling in the same direction
going in the same direction but

in a different line of traffic
10
changing lines of traffic
10
11
overtaking
11
12
turning to the right
12
13
turning to the left
13
14
reversing
14
15
changing to a lane reserved for traffic in

the opposite direction
15
16
coming from the right (at a junction)
16
17 had not observed a priority sign or a red light 17
Surname
First name
Date of birth
13
Address
Country
Tel. or email
Driving licence No.
Category
State the number of

boxes marked with a cross
Zip code
Country
Tel. or e-mail
7 Vehicle
Trailer:
Motor:
Make, type
Registration No.
Registration No.
8 Insurance company
Surname
Policy No.
valid
from
to

Address
Country
Tel. or e-mail
vehicle?
9 Driver
no
yes
Surname
First name
Date of birth
Address
Sketch of accident when impact occurred
Complete your sketch later: www.AccidentSketch.com

Indicate 1. the layout of the road 2. by arrows the direction
of the vehicles A, B 3. their position at the time of impact
4. the road signs 5. names of the streets or roads
Country
Tel. or email
Driving licence No.
Category

impact to vehicle A by an
arrow

impact to vehicle B by an
arrow
Your Sketch of the accident:
vehicle A:
14 My remarks:
* see insurance
certificate
Put a cross in each of the relevant boxes to help
9 Driver
yes
5 Witnesses: names, addresses, tel.
vehicle B:
15
Signatures of the drivers
15
14 My remarks:
AccidentSketch.com | Provided by ClaimMS GmbH | PO Box 111248 | D-57258 Freudenberg | www.Claim.MS

Infoline: +49 271 222 9 222 | eMail: Info@Claim.MS | www.Accidentsketch.com

Accident-Report English

Uploaded by

Copyright:

Available Formats

Accident-Report English

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Accident-Report English

Uploaded by

Copyright:

Available Formats

Accident Report Form

Does not constitute an admission of liability, just

2 Locality Country Place

3 Injuries even if slight

objects other than vehicles:

explain the drawing -* delete where appropriate:

* leaving a parking space / opening

entering a parking space

*emerging from a parking space, from private

*entering a parking space,

striking the rear of the other vehicle in the same

going in the same direction but

changing lines of traffic

turning to the right

turning to the left

changing to a lane reserved for traffic in

coming from the right (at a junction)

(see insurance certificate)

Agency (or bureau, or broker)

(see driving licence)

17 had not observed a priority sign or a red light 17

State the number of

(see insurance certificate)

Agency (or bureau, or broker)

(see driving licence)

Sketch of accident when impact occurred

Complete your sketch later: www.AccidentSketch.com

Driving licence valid until:

10 Indicate the point of initial

Your Sketch of the accident:

5 Witnesses: names, addresses, tel.

Signatures of the drivers

AccidentSketch.com | Provided by ClaimMS GmbH | PO Box 111248 | D-57258 Freudenberg | www.Claim.MS

Accident Report Form

Does not constitute an admission of liability, just

2 Locality Country Place

3 Injuries even if slight

objects other than vehicles:

explain the drawing -* delete where appropriate:

(see insurance certificate)

Agency (or bureau, or broker)

(see driving licence)

* leaving a parking space / opening

entering a parking space

*emerging from a parking space, from private

*entering a parking space,

striking the rear of the other vehicle in the same

going in the same direction but

changing lines of traffic

turning to the right

turning to the left

changing to a lane reserved for traffic in

coming from the right (at a junction)

17 had not observed a priority sign or a red light 17

State the number of

(see insurance certificate)

Agency (or bureau, or broker)

(see driving licence)

Sketch of accident when impact occurred