Jersey new jersey 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Claimant section. Enter your last name, middle name, first name, and address. If your mailing address differs, provide that as well. Don’t forget to include your telephone number, date of birth, and social security number.
3. If someone else should receive notices regarding this claim, complete Item #2 with their name and mailing address. Specify their relationship to you and provide a contact number.
4. In the Circumstances section, detail the date, time, and exact location of the occurrence. This information is crucial for processing your claim.
5. Describe the accident or occurrence clearly in the designated field. Include all relevant details that could support your claim.
6. List all witnesses' names and addresses who can corroborate your account of the incident.
7. Identify any state agencies or employees involved in causing your damages or injuries in the next section.
8. Provide information about other individuals or entities you believe are responsible for your injuries or damages.
9. Briefly describe any injuries, damages, and losses incurred due to the incident.
10. Finally, state the amount of your claim along with a basis for calculating these damages. Ensure you certify that all statements are true before submitting.

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