Car Accident Form
TLC Drivers Name
First Name
Last Name
What Car Number
Date of accident
-
Month
-
Day
Year
Date
Police Report Number:
Other Drivers Name and Phone Number
Other Drivers License Plate Number
Picture of Police Business Card File Upload
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Picture of Other Drivers Proof of insurance Card File Upload
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Picture of Other Drivers License File Upload
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Pictures of Other Vehicle Damage File Upload
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Picture of TLC Vehicle Damage
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Explanation of what happened:
Location the accident happened. Address preferred if not give cross roads.
Signature
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Should be Empty: