Submit a Claim
Vehicle Incident Report
Step 1 of 10 - General Information
If you are involved in an accident, please contact your local law enforcement authority as soon as it is safe to do so. If possible, take pictures of the vehicle(s) involved and gather contact information from witnesses.
Any person who knowlingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Date and Location
Date of the Accident (Date of Loss)
Date Format: MM slash DD slash YYYY
In what city did the incident occur?
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Your Vehicle Information
Vehicle Make (Example Nissan)
Vehicle Model (Example Altima)
The VIN number is located on the lower left side of the windshield or on the inside of the driver's door jam.
Were you able to drive the vehicle from the scene?
Was the vehicle towed from the scene?
Current Vehicle Location
Were any passengers in the vehicle at the time of the accident?
If yes, how many?
If you feel you are seriously injured, please seek medical attention before continuing this form.
Was anyone injured in the accident?
Injuries in my vehicle
Injuries in other vehicle(s)
Was anyone transported from the scene via ambulance?
Name of the medical care facility?
Tell us what happened in your accident
Was a citation/ticket issued at the scene?
Was a police report filed?
Police report number?
Was there an independent witness? (not involved in the accident)
Other Involved Party
Was there another party involved?
How Many Vehicles Were Involved?
Other Driver's Name
Other Driver's Insurance Card
Other Driver's Plate Number
Other Driver's VIN Number
Other Driver's Vehicle Make & Model
Photos of Vehicle Damage/Impact Area
Drop files here or
Please provide at least 3 photo of your vehicle damage, any other vehicle's damage, and photo of the accident area with a landmark or street sign.
Police Documents, Driver's License, Registration, Insurance Cards, Exchange of Information Report, etc.
Drop files here or
Text additional photos to 240-428-6084