Death or injury to a person, notify the police immediately. It is a crime to leave the scene of a fatal or personal injury accident. In addition, ALL involved drivers must file an accident report form (MV-104) within 10 days with the Department of Motor Vehicles (DMV). Failure to do so could result in license suspension.
More than $1,000 worth of damage to the property of any one person, ALL involved drivers must file an accident report form (MV-104) within 10 days with the DMV. Failure to do so could result in license suspension.
$1,000 or less worth of damage to the property of each of the parties involved, you must stop and exchange name, address, driver license number, insurance information and vehicle registration information with the other drivers. If a parked vehicle or other property is damaged, or if a domestic animal is hurt, you must locate the owner or contact police.
Use this form to exchange information with the other involved driver. Complete all sections on both sides of this form, then tear along the dotted lines.
Notify your insurance agent.
Copies of the accident report form (MV-104) are available at your local DMV office, or may be downloaded directly from the Department of Motor Vehicle. You may also obtain them by writing to: Public Service Bureau, Department of Motor Vehicles, Empire State Plaza, Swan Street Building, Albany, New York 12228.
|Date & Time:
||Name of Insurance Co. & Code
||Name of Agency:
|Street or route:
||Date of birth:
||Vehicle Plate No. & State
||Name of Insurance Agent / Address
||License # & State:
||Year & Make: