Download.pdf

1. Police called? Yes No
2. Other vehicle information:
Driver:
Name:
Address:
Phone:
Driver’s License:
Relationship to registered owner:
Registration:
Name of registered owner:
Address:
License Plate: Expiration Date:
Vehicle:
VIN:
Make:
Model:
Year: Color:
Insurance Company:
Policy Number:
Phone: Expiration Date:
Other passengers:
A. Name:
Age: Male Female
Address:
Phone:
B. Name:
Age: Male Female
Address:
Phone:
3. Accident Information
Police report taken? Yes No
Report Number:
Oficer Name:
Badge Number:
Time: AM / PM Date:
Location of collision:
Direction of travel:
Your vehicle:
Other vehicle:
Injuries:
Your own:
Your passengers:
Other driver:
Their passengers:
Pedestrians:
Area of Damage:
Your vehicle:
Other vehicle:
Other property:
North/South Street:

East/West Street:

Record description of the accident on back.
Diagram of Accident Scene:
Using these symbols sketch a diagram showing positions of all
vehicles, your position, stop lights, stop signs and pedestrians.

1 First Car
Your position
Stop sign

2 Second Car
Pedestrian
Stop light

3 Third Car

Witness
All products, coverages and discounts are not available in all areas. Insurance underwritten by a member of the Bristol West Insurance Group. “Foremost” and the “F” logo are registered trademarks of
FCOA, LLC, 5600 Beech Tree Lane, Caledonia, MI 49316. Bristol West Insurance Group and Bristol West are registered trademarks of Bristol West Holdings, Inc., 5701 Stirling Road, Davie, FL 33314.
The Foremost and Bristol West Companies are members of the Farmers Insurance Group
®, 4680 Wilshire Blvd. Los Angeles, CA 90010. 9000627 03/11
Foremost
® Auto
Accident Checklist
Keep a pen and a copy of this Accident Checklist in your
glove box. Policyholders call 1-800-527-3907 to ile a claim.
If you’re involved in an auto accident:
1. Stay as calm as possible.
2. Check for injuries. Safety is more important than vehicle
damage. Call an ambulance if needed.
3. Turn on your hazard lights. Use cones, warning triangles or
lares for safety.
4. Call the police, even for minor accidents.
5. Make immediate notes about the accident including the speciic
damages to all vehicles involved.
6. Be polite and state only the facts. Don’t tell the police or other
drivers that the accident was another driver’s fault or was your
fault. You likely don’t know all the facts. Let the police sort out
all the facts to establish what happened.
7. If a camera is available, and if it is safe to do so, take
photographs of the scene.
8. Notify your insurance agent about the accident immediately.
9. Please remember that getting the facts is important, but only
police oficers and insurance companies should investigate
the accident.
If you know of insurance fraud, report it to our Auto Fraud hotline
at 1-888-662-6616.
You can count on the value and expertise that comes with every
Foremost policy, along with the peace of mind that comes from
knowing that your policy is backed by expert claims service that
will get you back on the road quickly and fairly in the event of loss.
Keep a pen and a copy of this Accident Checklist in your
Accident Checklist
Nepa Insurance