Vehicle Damage Report Form

July 13, 2011

A Vehicle damage report form provides detailed information on the damage caused to a vehicle. This report form helps to make assessment of density of damage and loss to concerned company/department. This form also works as a base for insurance cover claim.

Sample Vehicle Damage Report Form

 

 

General Information

 

Title of Company/Organization_______________ Registration Number__________

Address_____________ Phone__________ Email_________ Fax___________

Report prepared by_____________ Designation_________ Phone_________

Damage Report Information

 

Type of Vehicle Damaged___________

Date of damage incident/accident____/____/____ Location of damage__________________

Vehicle License Number_________

Driver: Name_________  Driving License Number____________

Nature of Damage__________

Brief Description of Damage____________

Is the damage: Minor/Major______________

Any casualty of human life_______________

Description of Injuries___________________

Medical Treatment for Injuries____________

Person involved in damage________________

Activities of the above person while damage__________

Witnesses______________________________________

Is the vehicle insured, if yes provide details of insurance cover_______________
Name of Insurance Company____________

Cost of Damage_______________

Any Police complaint filed, if yes than provide details___________________

Signature______________  Date___/___/___

Report Submitted to____________ Signature of Recipient___________

 

Download Vehicle Damage Report Form in Word Format

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