Accident-Report English
Accident-Report English
1 Date of accident
Accidentsketch.com
Time
4 Material damage
other than to vehicles A and B:
no
no
yes
yes
Vehicle A
Circumstances
* see insurance
certificate
6 Insured/policyholder*
Vehicle B
12
Surname
Surname
First name
First name
Address
Address
ZIP code
Country
Tel. or e-mail
7 Vehicle
What happened?
* parked / stopped
entering a roundabout
circulating a roundabout
10
10
11
overtaking
11
12
12
13
13
14
reversing
14
15
15
16
16
Trailer:
Motor:
Make, type
Registration No.
Registration No.
Country of registration
Surname
Policy No.
Insurance Certificate
valid
from
to
no
yes
Surname
First name
Date of birth
13
Address
Country
Tel. or email
Driving licence No.
Category
Zip code
Country
Tel. or e-mail
7 Vehicle
Trailer:
Motor:
Country of registration
8 Insurance company
Make, type
Registration No.
Registration No.
Country of registration
Country of registration
8 Insurance company
Surname
Policy No.
Insurance Certificate
valid
from
to
no
yes
Surname
First name
Date of birth
Address
Country
Tel. or email
Driving licence No.
Category
Driving licence valid until:
11 Visible damage to
vehicle A:
14 My remarks:
* see insurance
certificate
6 Insured/policyholder*
Put a cross in each of the relevant boxes to help
9 Driver
yes
11 Visible damage to
vehicle B:
15
15
14 My remarks:
Accidentsketch.com
Time
4 Material damage
other than to vehicles A and B:
no
no
yes
yes
Vehicle A
Circumstances
* see insurance
certificate
6 Insured/policyholder*
Vehicle B
12
Surname
Surname
First name
First name
Address
Address
ZIP code
Country
Tel. or e-mail
7 Vehicle
Trailer:
Motor:
Make, type
Registration No.
Registration No.
Country of registration
Country of registration
8 Insurance company
Surname
Policy No.
Insurance Certificate
valid
from
to
no
yes
What happened?
* parked / stopped
entering a roundabout
circulating a roundabout
10
10
11
overtaking
11
12
12
13
13
14
reversing
14
15
15
16
16
Surname
First name
Date of birth
13
Address
Country
Tel. or email
Driving licence No.
Category
Zip code
Country
Tel. or e-mail
7 Vehicle
Trailer:
Motor:
Make, type
Registration No.
Registration No.
Country of registration
Country of registration
8 Insurance company
Surname
Policy No.
Insurance Certificate
valid
from
to
no
yes
Surname
First name
Date of birth
Address
Country
Tel. or email
Driving licence No.
Category
Driving licence valid until:
11 Visible damage to
vehicle A:
14 My remarks:
* see insurance
certificate
6 Insured/policyholder*
Put a cross in each of the relevant boxes to help
9 Driver
yes
11 Visible damage to
vehicle B:
15
15
14 My remarks: