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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'City Where Crash Occurred:' in the designated field. Ensure that you input the correct city name as this is crucial for accurate reporting.
Next, fill in the 'Date of Crash:' field using the required format (Month/Day/Year). For example, enter '11/4/11' for November 4, 2011.
Proceed to complete the driver and vehicle sections. Input your name, date of birth, mailing address, and daytime telephone number accurately.
For vehicle details, provide information such as year, make, model, license plate number, and VIN. This ensures all necessary data is captured.
Indicate whether you had an automobile liability policy in effect at the time of the crash by selecting 'YES' or 'NO.' If applicable, include your policy number and insurance agent's contact information.
Finally, review all entries for accuracy before signing your form after printing. Make sure to submit it within 15 days from the date of the crash.

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