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Vehicle Incident Report

Step 1 of 10 – General Information

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  • 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

  • MM slash DD slash YYYY
  • :
  • Your Vehicle Information

  • The VIN number is located on the lower left side of the windshield or on the inside of the driver’s door jam.
  • Towing Information

  • Passengers

  • Injuries

    If you feel you are seriously injured, please seek medical attention before continuing this form.
  • Accident Description

  • Witnesses

  • Other Involved Party

  • Photos

  • Drop files here or
    Max. file size: 256 MB, Max. files: 10.
      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.
    • Drop files here or
      Max. file size: 256 MB.
      • Text additional photos to 240-428-6084

      Email Us

      claims@whipclaims.com

      Call Us

      (855) 906-5949

      Fax Us

      (877) 890-0531