Please Read
Instructions on Reverse Side
D
EPARTMENT OF PUBLIC SAFETY
OKLAHOMA MOTOR VEHICLE COLLISION REPORT
PO Box 11415 Driver Compliance Division 3600 N. M L King Ave
Oklahoma City OK 73136-0415 Oklahoma City OK 73111
Submit Report if
Settlement Has Not Been Made
Collision Date Time No. of Vehicles
Involved
City County
Collision Location
(Street Name or Highway Number, Nearest Intersection)
VEHICLE NO. 1
(Your Vehicle)
Driver Name Owner Name
Same As Driver
Date
of Birth
DL No. DL State Date of
Birth
DL No. DL State
Damage Estimate
Street Street
City State Zip City State Zip
Vehicle
Year
Vehicle
Make
Vehicle
Model
Vehicle
Tag No.
Tag
State
Tag
Year
Total Injury Amount::
YOU WILL BE CONSIDERED UNINSURED AND SUBJECT TO SUSPENSION OF YOUR DRIVER LICENSE IF THE FOLLOWING SECTION IS INCOMPLETE:
Insurance
Company
Insurance
Agent Name
Phone
Policy
Number:
Address
Policy Period From To City State Zip
Injuries and/or Death
IMPORTANT: ATTACH ITEMIZED DOCTOR’/HOSPITAL/PHARMACY BILLS (ATTACH ADDITIONAL FORMS IF NECESSARY)
Name Address Age Sex Driver Passenger Pedestrian Injured Killed
VEHICLE NO. 2
Driver Name Owner Name
Same As Driver
Other Driver/Owner
Date
of Birth
DL
Number
DL
State
Date
of Birth
DL
Number
DL
State
Date of Birth
must be
included
before action can be
taken under the
Financial
Responsibility Law
Street Street
City State Zip
Code
City State Zip
Code
Vehicle
Make
Vehicle
Year
Vehicle
Type
Vehicle
Tag No.
Tag
State
Tag
Year
INSURANCE INFORMATION OF OTHER DRIVER: INSURANCE DENIAL ATTACHED? YES NO
Insurance
Company
Insurance
Agent Name
Phone
Policy
Number:
Address
Policy Period From To City State Zip
VEHICLE NO. 3
Driver Name Owner Name
Same As Driver
Other Driver/Owner
Date
of Birth
DL
Number
DL
State
Date
of Birth
DL
Number
DL
State
Date of Birth
must be
included
before action can be
taken under the
Financial
Responsibility Law
Street Street
City State Zip
Code
City State Zip
Code
Vehicle
Make
Vehicle
Year
Vehicle
Type
Vehicle
Tag No.
Tag
State
License
Year
INSURANCE INFORMATION OF OTHER DRIVER: INSURANCE DENIAL ATTACHED? YES NO
Insurance
Company
Insurance
Agent Name
Phone
Policy
Number:
Address
Policy Period From To City State Zip
Describe what you think caused the collision. Please refer to vehicles by number:
I STATE THAT THE INFORMATION ON THIS REPORT IS TRUE
AND
ACCURATE TO THE BEST OF MY KNOWLEDGE
I AM: Driver Owner Attorney/Corp./Agency Officer Insurance Agent
Signature Phone Date
DPS FR307 024 012008
Print Form
DEPARTMENT OF PUBLIC SAFETY
OKLAHOMA MOTOR VEHICLE COLLISION REPORT
P.O. Box 11415 Driver Compliance Division 3600 N. M L King Ave
Oklahoma City OK 73136-0415 405.425.2098 Oklahoma City OK 73111
INSURANCE INFORMATION EXCHANGE
Police Officer DATE
Use this form to exchange your information with the other party at
the scene of the collision.
Driver Name
Driver License No. Date of Birth Insurance Company Phone
Address Phone Agent Name
City State Zip Address
Vehicle Owner:
‘ same as driver
City State Zip
Address Phone Policy No.
City State Zip Policy Effective Date Policy Expiration Date
Driver License No. Date of Birth Vehicle Make Model Year Tag No./State
**The official Oklahoma Traffic Collision Report, the police investigative report, can be obtained by calling Records Management at 405.425.2262**
INSTRUCTIONS
WHILE AT THE SCENE OF THE COLLISION
1. Print your name and insurance information legibly in the form above.
2. Give your information to the other driver and then you receive their information.
3. Contact their insurance agent and your insurance agent to report the collision and to file the proper claim forms.
If the insurance information provided above is denied or non-existent or you did not have the opportunity
to obtain the above information, you will need to complete the reverse side of this form and submit
within one year from the date of the collision.
4.
Using this form which contains the other party’s information (if investigated by law enforcement personnel), complete all
blanks; incomplete reports will be returned. Date of birth must be included for adverse driver and/or owner; your
insurance information must also be included.
5.
Report must be dated and signed.
6.
Attach the following appropriate documents as evidence of personal injury or property damage.
(a)
PERSONAL INJURY - Copies of itemized doctor, hospital, and/or pharmacy bills incurred as a result of the collision.
(b)
VEHICLE DAMAGE - An itemized estimate of repair or total loss statement for damages caused by the collision, dated and
signed by an authorized representative of a garage or body shop. Do not send any other supporting evidence such as pictures,
copies of checks, or other type of documents or diskettes.
(c)
PROPERTY DAMAGE, OTHER THAN MOTOR VEHICLE - An itemized estimate or statement of repair due to the collision
separately listing the cost of materials and the cost of labor dated and signed by a qualified professional or your receipts.
(d)
Insurance denial from other party’s company if a claim was filed.
7.
Upon completion, mail the report to the Department of Public Safety at the above address.
DPS FR307 024 012008
