Johnson Insurance

Fender Bender Form

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Time of Accident: am / pm Street: City: Province: Speed: Your km/h: Other km/h: Weather conditions: Road conditions: FENDER BENDER GUIDE We hope you are never involved in an accident, but if you are, we've created this simple guide to help you know what questions to ask and what information to record. Stay calm. If the vehicles are drivable and it is safe to do so, move them safely out of traffic. Apply First Aid. Call the police, and if necessary, an ambulance. Take photos of the accident scene if possible. Take brief notes below. AFTER AN ACCIDENT OTHER VEHICLE DETAILS INVESTIGATING OFFICER WITNESS ADDITIONAL NOTES ACCIDENT DETAILS Description of how the accident happened: Description of your vehicle's damage: Description of other vehicle's damage: Owner: Address: Home/Cell Phone: Driver: Address: Home/Cell Phone: Driver's Licence Number: Vehicle Licence Plate Number: Insurance Company: Policy Number: Vehicle Make: Vehicle Model: Vehicle Year: Vehicle Colour: Number of Passengers: Name of Injured: Where Treated: Name: Phone: Badge Number: Local Police Detachment: Name: Address: Home/Cell Phone: Remember: You should only call your insurance provider for claims reporting when you are safely away from the accident and can clearly recount the details. If you are a Johnson Insurance policy holder you can reach us 24/7 at: 1-844-229-1272 month/day/year SKETCH OF ACCIDENT SCENE (try to estimate distances) Date of Accident:

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