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Report a Vehicle Accident

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Report a Vehicle Accident or Vandalism

Please Note: This form is for Transportation Services Division leased state vehicles only. Vehicle must have a G or SG license plate.

Please use the form below to submit a vehicle accident or vandalism.

ACCIDENT DETAILS
Date of Loss:
MM slash DD slash YYYY
Location of Accident or Incident:
Description of Accident or Incident:
VEHICLE INFORMATION
Vehicle (Year, Make & Model):
License Plate Number:
Driver Name:
First
Driver License Number*
Current DDC
Max. file size: 1,000 MB.
Phone:
Agency:
Location of Vehicle:
Damage:
CONTACT
Contact Person:
Email Address:
Phone:
Person Reported By:
Date:
MM slash DD slash YYYY
Adverse Driver/Owner:
CAPTCHA