Road Traffic Accident Form Please take time to complete the RTA form below. This will ensure we have a record of all the information we require. Personal Details: Name (required) Address (required) Email (required) Telephone No. (required) DOB (required) Driving Licence No. Company Name. Insurance Company Policy No. Vehicle Type Reg No. Accident Details: Date and Time of Accident (required) [datetime* datetime-160 date-format:dd/mm/yy time-format:HH:mm first-day:1] Who was at fault? Give Reason Did anyone admit fault? Accident Description Vehicle Damage Driver of other Vehicle (name, DOB, address, insurance details, contact number, email address) Witness Information I confirm the above information is true and correct
