Non-stop collision self-reporting form

  • 1 Collision self-reporting form
  • 2 Incident details
  • 3 About your vehicle
  • 4 Other details
  • 5 Witness details
  • 6 Complete

You can use this form to report a damage only road traffic collision you’ve had with someone where they either:

  • drove off without exchanging details
  • damaged your vehicle by driving dangerously or carelessly

For any other collisions, including if someone was injured, visit our road traffic incidents page.

Before you complete our form, we need to know what evidence you have from the collision.

Unfortunately we will not be able to investigate this collision without the registration number of the vehicle who collided with you. This also means you cannot report this to us by phone or by visiting a police station as you’ll be asked to provide the same information

However this won’t affect any civil claims. Contact your insurance company who will be able to help you further and progress any claim.

WITNESS STATEMENT

Criminal Procedure Rules, r27.2; Criminal Justice Act 1967, s.9; Magistrates’ Courts Act 1980, s.5B

 

This statement, signed by me, is true to the best of my knowledge and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully stated in it anything which I know to be false or do not believe to be true.

By typing your name below you are signing this document electronically. In doing so, you certify that this forms your electronic signature as provided under section 7 Electronic Communications Act 2000.

Your details

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