Free template
Accident Information Exchange Form
By Serdar Arslan, editor · Last reviewed · How we research
Right after a crash, it is easy to forget to ask for a policy number or a witness's phone number. This printable form gives you one place to record the details insurers usually ask for: both drivers, both vehicles, insurance companies, witnesses, the responding police agency, and the report number.
Print a copy and keep it in your glove box with a pen. Most states require drivers involved in a crash to exchange certain information and, in some situations, to report the crash to police or the state motor vehicle agency; check your state's rules on /car-accident-laws.
Safety comes first. Move to a safe spot if you can, call 911 if anyone is hurt, and only fill in the form when it is safe. Stick to facts and avoid discussing who was at fault.
ACCIDENT INFORMATION EXCHANGE FORM Keep this form in your glove box. Fill it in at the scene only when it is safe to do so. ================================================== SECTION 1 – THE ACCIDENT Date: [Date of the accident] Time: [Approximate time] Location: [Location (street, city, state)] Weather / road conditions: [Weather and road conditions] SECTION 2 – DRIVER 1 (YOU) Name: [Driver 1 (you) – full name] Address: [Driver 1 (you) – address] Phone: [Driver 1 (you) – phone] Driver's license # / state: [Driver 1 (you) – driver's license number and state] Registered owner: [Driver 1 (you) – registered owner, if different] Vehicle: [Driver 1 (you) – vehicle year, make, model, color] Plate / state: [Driver 1 (you) – license plate and state] VIN: [Driver 1 (you) – VIN (optional)] Insurance company: [Driver 1 (you) – insurance company] Policy #: [Driver 1 (you) – policy number] Insurer claims phone: [Driver 1 (you) – insurer claims phone] Visible damage: [Driver 1 (you) – visible vehicle damage] SECTION 3 – DRIVER 2 (OTHER DRIVER) Name: [Driver 2 (other driver) – full name] Address: [Driver 2 (other driver) – address] Phone: [Driver 2 (other driver) – phone] Driver's license # / state: [Driver 2 (other driver) – driver's license number and state] Registered owner: [Driver 2 (other driver) – registered owner, if different] Vehicle: [Driver 2 (other driver) – vehicle year, make, model, color] Plate / state: [Driver 2 (other driver) – license plate and state] VIN: [Driver 2 (other driver) – VIN (optional)] Insurance company: [Driver 2 (other driver) – insurance company] Policy #: [Driver 2 (other driver) – policy number] Insurer claims phone: [Driver 2 (other driver) – insurer claims phone] Visible damage: [Driver 2 (other driver) – visible vehicle damage] SECTION 4 – PASSENGERS [Passengers in each vehicle (names, phone)] SECTION 5 – WITNESSES Witness 1: [Witness 1 – name and phone] Witness 2: [Witness 2 – name and phone] SECTION 6 – POLICE AND TOWING Police agency: [Police agency that responded] Officer name / badge: [Officer name and badge number] Report / incident #: [Police report or incident number] Tow company / vehicle location: [Tow company and where vehicles were taken] SECTION 7 – PHOTOS AND NOTES Photos taken: [Photos taken (what and by whom)] What happened (facts only): [Short factual description of what happened] SECTION 8 – SIMPLE SKETCH [ Draw the road, lanes, direction of each vehicle, and point of impact here ] -------------------------------------------------- Reminder: exchange information, but do not argue about fault or sign anything at the scene.
Tips
- Photograph the other driver's license, insurance card, and plate if they agree; it reduces copying errors.
- Check that the registered owner and the driver are the same person. If not, write down both names.
- Ask witnesses for a phone number even if police are on the way; officers do not always list every witness.
- Write the description of what happened in plain facts. Avoid statements about fault or apologies.
- Note any nearby cameras (stores, traffic cameras, doorbells), since footage is often overwritten within days.
Sending it and keeping proof
Keep a copy of everything you send. If a deadline or a response time matters, send letters by a method that gives you proof of delivery, such as certified mail with a return receipt, or email with a read receipt, and note the date in your claim file. Many insurers and agencies also accept uploads through an online portal, so save the confirmation screen or email.