Accident Report Form

Print this form and keep it with your liability card in your car.


CIS Insurance Brokers (905) 889-2268
Accident Summary:
Time: Date:


Third Party Details:
Insurance Co.: Policy#:
Agent: Phone:


Driver Name: Phone:
Witness Name: Phone:
Police Constable Name:
Division No. Badge No.
Phone No. Report No.
Traffic Charge Laid?

Copyright 1999-2009 CIS Insurance Brokers (Canada) Ltd. All rights reserved.
Revised: June, 2010