Accident Report Form printable pdf download

GEORGIA DEPARTMENT OF DRIVER SERVICES

SAFETY RESPONSIBILITY UNIT

P.O. BOX 80447 CONYERS, GEORGIA 30013

678-413-8400

ACCIDENT REPORT

PLEASE READ INSTRUCTIONS CAREFULLY!! THIS FORM MUST BE FILLED OUT COMPLETELY IN ORDER TO

AVOID FILLING OUT A SUPPLEMENTAL REPORT.

1. Answer all questions to the best of your knowledge. If unable to answer any questions write “not known”.

2. Print all names and addresses.

3. Sign the report in the space provided on the reverse side.

4. Report must be complete as to the exact names, birth dates, and driver’s license numbers.

5. Use a second report form or a sheet of plain paper of the same size to report additional vehicles, injured

persons, witnesses or any other information for which there is insufficient space.

DATE

PLACE WHERE ACCIDENT

OF ACCIDENT:_______________________

OCCURRED (CITY/COUNTY):______________________________

YOUR VEHICLE #1:

Year: ____________ Make: _______________ Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)

Driver Name:_________________________ Driver’s License #:__________________ Driver’s Birth Date _________

Address: ___________________________________________ City:___________________

Zip: _____________

Owner: _____________________________ Owner’s License #: __________________ Owner’s Birth Date: ________

Address: ___________________________________________ City:____________________

Zip: _____________

VEHICLE #2:

Year: __________ Make: ________________

Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)

Driver Name:__________________________ Driver’s License #: ________________ Driver’s Birth Date: _________

Address____________________________________________ City:___________________

Zip: _____________

Owner: _____________________________ Owner’s License #: _________________ Owner’s Birth Date: ________

Address: __________________________________________ City:______________________ Zip: _____________

VEHICLE #3:

Year: __________ Make: ________________

Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)

Driver Name:___________________________ Driver’s License #: _______________ Driver’s Birth Date: ________

Address___________________________________________ City:______________________ Zip: _____________

Owner: _______________________________ Owner’s License #: ______________ Owner’s Birth Date: _________

Address: __________________________________________ City:______________________ Zip: _____________

DDS-190 (rev 01/16)

Accident Report Form