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Fill in Your Vermont Report Form

The Vermont Report form is a document required by the Vermont Department of Motor Vehicles for reporting motor vehicle crashes. This form must be completed by the operators of all vehicles involved in an accident that results in injury, death, or property damage exceeding $3,000. Timely submission of this report is crucial, as it must be filed within 72 hours of the incident to avoid potential civil penalties.

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In the aftermath of a motor vehicle crash, understanding the necessary steps to report the incident can feel overwhelming. The Vermont Report form is a crucial document designed to streamline this process, ensuring that all relevant information is collected and submitted efficiently. This form must be filled out by the operator of every vehicle involved in a crash that results in injury, death, or property damage exceeding $3,000. It is essential to complete the report within 72 hours of the incident, regardless of whether the vehicle was in motion or parked. The form captures vital details such as the time and location of the crash, the identities of all operators and occupants, and specifics about each vehicle involved. Additionally, it addresses the need for insurance information, emphasizing that proof of liability insurance must be provided to avoid potential penalties. By carefully following the guidelines laid out in the Vermont Report form, individuals can ensure compliance with state laws while facilitating the necessary communication with law enforcement and insurance providers.

⇩ Vermont Report PDF Form

Dos and Don'ts

When filling out the Vermont Report form, consider the following dos and don'ts:

Ensure all information is completed in full, using ink or typing.
Report the crash within 72 hours, even if the vehicle was parked.
Include the correct details for every vehicle involved in the crash.
Provide accurate insurance information to avoid penalties.
Sign the form where indicated to validate your report.

Do not leave any sections blank; incomplete forms may result in penalties.
Avoid using pencil or non-permanent ink, as this can lead to illegibility.
Do not forget to report the crash to your insurance company as well.
Do not submit the form without verifying all information for accuracy.
Do not detach any parts of the form; it must be submitted as a whole.

Similar forms

The Vermont Report form is similar to the police accident report, which is completed by law enforcement officers after responding to a crash. Like the Vermont Report, the police report gathers details about the incident, including the involved parties, vehicle information, and any injuries. Both documents serve as official records that can be used in insurance claims and legal proceedings, ensuring that accurate information about the crash is documented.

Another document comparable to the Vermont Report is the insurance claim form. This form is submitted to an insurance company after a crash to initiate the claims process. Similar to the Vermont Report, it requires detailed information about the incident, including the date, time, and circumstances of the crash. Both documents aim to provide a clear account of what happened to facilitate the resolution of claims and potential compensation for damages.

The DMV accident report form is also akin to the Vermont Report. This form is specifically used to report accidents to the Department of Motor Vehicles. Like the Vermont Report, it collects essential information about the vehicles and drivers involved. Both forms help maintain accurate records of accidents for regulatory purposes and assist in tracking driving patterns and safety issues.

The personal injury claim form shares similarities with the Vermont Report as well. This form is used to document injuries sustained in an accident for legal claims. Both documents require detailed accounts of the incident, including witness statements and medical information. They aim to establish liability and the extent of damages suffered, making them crucial for pursuing compensation.

The vehicle damage report is another document that resembles the Vermont Report. This report is used to document the extent of damage to vehicles involved in a crash. Like the Vermont Report, it requires detailed descriptions of the vehicles and the nature of the damage. Both documents serve to evaluate the financial implications of the accident for insurance purposes.

The traffic accident report form used in other states is similar to the Vermont Report. Each state has its own version, but they all collect similar information about the crash, such as the time, location, and parties involved. This uniformity ensures that accidents are reported consistently across jurisdictions, making it easier for insurance companies and law enforcement to process claims and investigate incidents.

The witness statement form can also be compared to the Vermont Report. This form collects accounts from individuals who witnessed the crash. While the Vermont Report focuses on the involved parties, both documents aim to establish a factual basis for understanding the accident. Witness statements can provide additional context and clarity, complementing the information found in the Vermont Report.

The medical report following an accident is another document that aligns with the Vermont Report. This report details the injuries sustained by individuals involved in the crash. Both documents serve to establish the impact of the accident on those involved, with the Vermont Report documenting the incident and the medical report providing evidence of injuries. Together, they are vital for insurance claims and legal proceedings.

The AAA International Driving Permit Application form is a vital document for drivers intending to operate vehicles abroad, as it facilitates the legal recognition of their driving credentials. This form not only certifies a driver’s eligibility but also provides necessary translations of their state-issued driver’s license into multiple languages, enabling smoother travel in foreign countries. For those interested in obtaining this permit, more detailed information can be found at onlinelawdocs.com/aaa-international-driving-permit-application/.

The property damage report is similar to the Vermont Report in that it specifically addresses damages to property as a result of an accident. Like the Vermont Report, it requires detailed descriptions of the property affected and the extent of the damage. Both reports are essential for determining liability and compensation for damages incurred during the crash.

Finally, the accident reconstruction report bears resemblance to the Vermont Report. This report is prepared by experts who analyze the crash to determine how it occurred. While the Vermont Report documents the initial details of the accident, the reconstruction report delves deeper into the mechanics of the crash. Both documents are crucial for understanding the factors that contributed to the incident and can be used in legal cases to establish fault.

Common mistakes

Incomplete Information: One of the most common mistakes is failing to fill out all sections of the form. Each part is crucial for a complete report. Leaving any section blank can lead to delays or complications in processing your report.
Incorrect Dates: Entering the wrong date of the crash can create confusion. Make sure to double-check the date and time to ensure accuracy. This detail is essential for both legal and insurance purposes.
Missing Insurance Details: Not providing complete insurance information is a significant error. You must include the name of your insurance company, policy number, and coverage period. Failure to do so may result in penalties or issues with your license.
Neglecting Occupant Information: Forgetting to list all occupants in the vehicles involved can lead to incomplete records. This information is vital for understanding the full impact of the crash and for any potential claims.
Failure to Sign: Not signing the form is a simple yet critical mistake. Your signature indicates that the information provided is accurate and complete. Without it, the report may not be accepted.
Providing Inaccurate Vehicle Details: Incorrectly listing vehicle information, such as make, model, or year, can cause complications. Ensure that all vehicle details match the official records to avoid discrepancies.

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	REPORT OF A MOTOR VEHICLE CRASH

DEPARTMENT OF MOTOR VEHICLES			FOR OFFICE USE ONLY
Agency of Transportation	A crash with more than 2 vehicles involved must fill	DMV Crash Number
120 State Street	out as many forms as needed to include all vehicles
Montpelier, Vermont 05603-0001	out as many forms as needed to include all vehicles
Montpelier, Vermont 05603-0001	involved in the crash.
(voice) 802.828.2050	involved in the crash.

dmv.vermont.gov

ALL INFORMATION REQUESTED MUST BE COMPLETED IN FULL IN INK OR TYPEWRITTEN

THE OPERATOR OF EVERY MOTOR VEHICLE INVOLVED IN A CRASH WHICH RESULTS IN INJURY OR DEATH OR TOTAL PROPERTY DAMAGE OF $3,000.00 OR MORE, MUST MAKE A REPORT ON THIS FORM WITHIN 72 HOURS TO THE ABOVE ADDRESS. YOU MUST REPORT EVEN IF VEHICLE WAS PARKED. THE FAILURE OR REFUSAL OF ANY PERSON TO REPORT MAY BE PUNISHABLE BY A CIVIL PENALTY.

TIME OF CRASH DAY OF WEEK

A.M.

P.M.

MONTH/DAY/YEAR OF CRASH

PLACE OF CRASH (CITY OR TOWN)

STREET/ROUTE/HIGHWAY OF CRASH

IF YOUR (OPERATOR #1) ADDRESS IS DIFFERENT FROM THE ADDRESS ON DMV RECORDS AND THIS FORM IS SIGNED BY YOU THIS FORM

WILL BE CONSIDERED TO BE A NOTICE OF ADDRESS CHANGE AND YOUR ADDRESS WILL BE CHANGED ON DMV RECORDS.

YOUR VEHICLE ~ NO. 1

NUMBER OF OCCUPANTS

OTHER VEHICLE ~ NO. 2

NUMBER OF OCCUPANTS

OR PEDESTRIAN OR BICYCLIST

OPERATOR NAME: LAST

FIRST

MIDDLE

OPERATOR NAME: LAST

FIRST

MIDDLE

STREET OR BOX NO.

CITY OR TOWN

STATE

CITY OR TOWN

STATE

ZIP CODE

DATE OF BIRTH

GENDER

ZIP CODE

DATE OF BIRTH

GENDER

OPERATOR’S LICENSE NO.

CLASS

STATE

OPERATOR’S LICENSE NO.

CLASS

STATE

IDENTIFICATION NUMBER

PLATE NUMBER

PLATE STATE

IDENTIFICATION NUMBER

PLATE NUMBER

PLATE STATE

VEHICLE YEAR

VEHICLE MAKE

VEHICLE MODEL

VEHICLE TYPE

VEHICLE YEAR

VEHICLE MAKE

VEHICLE MODEL

VEHICLE TYPE

TRAILER YEAR

TRAILER MAKE

TRAILER MODEL

TRAILER PLATE #

TRAILER YEAR

TRAILER MAKE

TRAILER MODEL

TRAILER PLATE #

COMMERCIAL

YES

HAZARDOUS

YES

COMMERCIAL

YES

HAZARDOUS

YES

VEHICLE

MATERIAL

VEHICLE

MATERIAL

ACTUAL COST

IF THE CRASH INVOLVED A PEDESTRIAN OR A BICYCLIST, COMPLETE

ACTUAL COST

OF VEHICLE #1

THE FOLLOWING INFORMATION

OF VEHICLE #2

REPAIRS

WHAT WAS PEDESTRIAN OR BICYCLIST DOING

REPAIRS

PROPERTY

WALKING WITH TRAFFIC

PLAYING IN ROAD

UNKNOWN

PROPERTY

WALKING AGAINST TRAFFIC

GETTING ON/OFF VEHICLE

DAMAGE OTHER

THAN VEHICLE

NOT IN ROADWAY

PUSHING VEHICLE

THAN VEHICLE

APPROXIMATE

CROSSING INTERSECTION

WORKING ON VEHICLE

APPROXIMATE

COST OF

CROSSING NOT AT AN

RIDING/PUSHING BIKE

COST OF

PROPERTY

INTERSECTION

PROPERTY

REPAIRS

OTHER:

PROPERTY OWNER’S NAME

AND ADDRESS:

DESCRIBE INJURY:

OCCUPANT DATA

THE INFORMATION BELOW IS REQUIRED FOR YOURSELF AND ALL OCCUPANTS IN ALL VEHICLES

(ATTACH ADDITIONAL SHEETS IF THERE IS NOT ENOUGH ROOM BELOW)

THIS INFORMATION IS REQUIRED

OCCUPANT’S NAME AND ADDRESS

NATURE AND EXTENT OF

NAME OF HOSPITAL

WAS

POSITION

AGE

SEATBELT

OCCUPANT

(USE THE FIRST LINE FOR YOURSELF EVEN IF NOT

INJURY

INJURED TAKEN TO

VEH

WITHIN

GENDER

THROWN

INJURED

(STATE “NONE” IF NOT INJURED)

VEHICLE

OCC.

HARNESS

FROM

USED

VEHICLE

YOURSELF

DRIVER

CONTINUE ON NEXT PAGE

TA-VA-04 (d) INTERNET 04/2012 REB

DESCRIBE IN YOUR OWN WORDS WHAT HAPPENED (ATTACH SHEET IF NECESSARY)

WAS THIS CRASH INVESTIGATED BY AN OFFICER?	YES	NO	IF YES, GIVE NAME OF OFFICER:

OFFICER’S DEPARTMENT:


WERE YOU DRIVING A COMMERCIAL VEHICLE?		Yes	No

WAS THE VEHICLE TRANSPORTING HAZARDOUS MATERIALS?			Yes	No

IF YES, GIVE NAME OF MATERIAL


					DATE OF REPORT
OPERATOR SIGN HERE

CONTINUE ON NEXT PAGE

IMPORTANT: YOU MUST FURNISH THE INSURANCE INFORMATION REQUESTED.

Vermont law requires that any person involved in a crash which has resulted in bodily injury or death to any person or whereby the motor vehicle then under his control or any other property is damaged in an aggregate amount to the extent of $3,000 or more must furnish the commissioner with satisfactory proof that a standard provisions automobile liability insurance policy was in full force and effect at the time of the crash.

Any person who fails to furnish satisfactory proof that liability insurance was in force at the time of the crash may be required to obtain and furnish proof that Financial Responsibility Insurance has been obtained covering such person in the future operation of any motor vehicle.

(OPERATOR #1) MUST COMPLETE BOTH SECTIONS BELOW IN FULL. IF YOU FAIL TO GIVE FULL INFORMATION BELOW, IT WILL BE ASSUMED THAT YOU DO NOT HAVE AUTOMOBILE LIABILITY INSURANCE AND A SUSPENSION OF YOUR LICENSE/PRIVILEGE TO OPERATE IN VERMONT WILL BE ISSUED.

DMV CRASH NUMBER

Was an Automobile Liability Insurance policy, providing you AT LEAST $25,000/$50,000 bodily injury and $10,000 property

damage insurance in effect on the date of the above crash? You must answer Yes or No.

Yes

Name of your (Operator 1) Insurance Company (NOT AGENT):

Insurance Company Mailing

Address:

Policy Number:

Policy Period From:

Name of Policy Holder:

Address:

Name of Operator at the time of the Crash:

Date of Crash:

Is this motor vehicle covered by a Certificate of Self-Insurance?

Yes

If yes, certificate number:

DO NOT DETACH FORM SR-21A

VERMONT DEPARTMENT OF MOTOR VEHICLES MONTPELIER VERMONT

DMV CRASH NUMBER

VERMONT

Name of insurance company with whom you are insured for liability or damage to others (For Operator #1):

Insurance Company mailing address:

Policy Number:

Policy Period From:

Date of Crash:

At or near (Town/City):

Make of your vehicle:

Year:

Type:

VIN:

Operator:

Address:

Name of Policy Holder:

Signature of Operator:

IMPORTANT! ! THIS CRASH SHOULD ALSO BE REPORTED DIRECTLY TO YOUR INSURANCE COMPANY. FAILURE TO REPORT MAY JEOPARDIZE YOUR AUTOMOBILE LIABILITY

DO NOT WRITE IN THE SECTION BELOW – IT IS FOR USE OF INSURANCE COMPANY ONLY

TO INSURANCE COMPANY :

Return this form in 15 days if no policy, or insufficient policy was in effect as alleged by motorist. IF NOTIFICATION IS NOT RECEIVED WITHIN 15 DAYS,

IT WILL BE ASSUMED THE REQUIRED INSURANCE WAS IN EFFECT AT THE TIME OF THE CRASH.

TO COMMISSIONER OF MOTOR VEHICLES, MONTPELIER, VERMONT 05603-0001

With regard to an insurance policy for the policy holder named on the reverse side hereof the undersigned insurance company advises you in accordance with the items checked below :

1.No such policy was in effect at the time of the crash.

2.Our policy applies to the owner of the vehicle but does not apply to the operator of the vehicle involved in the crash.

3.Our policy affords limits of liability less than $25,000/$50,000 bodily injury and $10,000 property damage (indicate actual limits under remarks).

REMARKS :

NAME OF INSURANCE COMPANY :	BY :

DATE :		AUTHORIZED REPRESENTATIVE

Documents used along the form

When dealing with a motor vehicle crash, several forms and documents may accompany the Vermont Report form. Each of these documents serves a specific purpose and can help ensure that all necessary information is collected and processed correctly. Below is a list of commonly used forms that you might encounter.

DMV Crash Number Form: This form is used to assign a unique identification number to the crash report. It helps track the incident through the Department of Motor Vehicles (DMV) system.
SR-21 Form: This form is a proof of insurance document that the insurance company must complete. It confirms whether the driver had valid insurance coverage at the time of the crash.
Texas RV Bill of Sale: This legal document illustrates the sale and purchase of a Recreational Vehicle in Texas, providing proof of ownership and detailing the transaction between buyer and seller. For more information, visit TopTemplates.info.
Accident Report Form: This document is often filled out by law enforcement at the scene. It includes details about the crash, such as the location, involved parties, and any citations issued.
Witness Statement Form: This form collects accounts from witnesses who observed the crash. Their statements can provide additional context and details that may be crucial for investigations.
Medical Report: If injuries occurred, a medical report may be required. This document outlines the nature and extent of any injuries sustained by those involved in the crash.
Insurance Claim Form: This form is submitted to the insurance company to initiate a claim for damages or injuries resulting from the crash. It provides essential information about the incident and the parties involved.
Property Damage Assessment Form: This document details the damage to vehicles and property involved in the crash. It is often used to estimate repair costs and determine liability.

Understanding these forms can help you navigate the aftermath of a crash more effectively. Each document plays a vital role in ensuring that all necessary information is recorded and that the appropriate actions are taken. If you have any questions about these forms or need assistance, it's important to seek guidance from a qualified professional.

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