The Tennessee Driver Form is an essential document that must be completed by individuals involved in an automobile crash in Tennessee. This report serves to inform the Department of Safety and Homeland Security about the details of the incident, including any injuries or damages. It’s crucial to submit this form within twenty days of the crash to avoid potential penalties, such as the suspension of your driver’s license.
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The Tennessee Driver form is an essential document for individuals involved in automobile crashes within the state. This form must be completed and submitted to the Tennessee Department of Safety and Homeland Security if there are injuries, fatalities, or property damage exceeding $400. It captures vital information, including the date and location of the crash, vehicle details, and personal information of both the driver and vehicle owner. Additionally, it addresses insurance coverage, requiring the submission of relevant policy details for verification. Timely submission is crucial; the form must be mailed within twenty days of the incident to avoid potential penalties, such as the suspension of driving privileges. Understanding the requirements and implications of this form can aid individuals in navigating the aftermath of an accident with greater clarity and compliance.
TENNESSEE DEPARTMENT OF SAFETY
AND HOMELAND SECURITY
OWNER / DRIVER REPORT
IMPORTANT: COMPLETE FORM BELOW AND MAIL TO: TN DEPARTMENT OF SAFETY AND HOMELAND SECURITY P.O. BOX 945
NASHVILLE, TN 37202-0945
DATE OF CRASH:
PLACE OF CRASH:
Month/Day/Year
VEHICLE MAKE:
VEHICLE YEAR:
NAME OF OPERATOR:
First
Last
ADDRESS:
Number
Street
DRIVER LICENSE NUMBER:
STATE:
NAME OF OWNER:
WERE THERE INJURIES OR DEATH INVOLVED IN THIS CRASH? WERE THERE DAMAGES TO YOUR VEHICLE?
IF YES, WERE THEY LESS THAN $1,500?
OR GREATER THAN $1,500
WERE THERE DAMAGES TO STATE OR LOCAL PROPERTY?
IF YES, WERE THEY LESS THAN $400?
OR GREATER THAN $400
City
County
VEHICLE TYPE:
DOB:
MiddleMonth/Day/Year
State
Zip
EXPIRATION DATE:
YES
NO
IF OVER $1,500, ENTER AMOUNT
IF OVER $400, ENTER AMOUNT
IF AVAILABLE, LIST THE FOLLOWING INFORMATION ON THE OTHER DRIVER INVOLVED IN THIS CRASH:
Last NameFirst NameMiddle Initial Driver License Number
DID YOU HAVE LIABILITY INSURANCE COVERAGE FOR THIS CRASH?
IF YES, PROVIDE COMPLETE INFORMATION BELOW:
NAME OF INSURANCE COMPANY (NOT AGENCY):
POLICY NUMBER:
POLICY PERIOD:
FROM:
TO:
NAME OF POLICYHOLDER:
NAME OF INSURANCE REPRESENTATIVE (AGENCY) WHO ISSUED POLICY:
NOTE: THE INSURANCE INFORMATION YOU PROVIDE WILL BE FORWARDED TO THE INSURANCE COMPANY FOR VERIFICATION.
Signature
Date
SF-0395 (Rev. 12/18)
RDA 1348
TENNESSEE DEPARTMENT OF SAFETY AND HOMELAND SECURITY
As set forth under the provisions of 55-12-104, T.C.A., you must file, or have filed in your behalf, a personal report with the Department of Safety and Homeland Security, if you were involved in an automobile crash as an owner or driver involving death or injury, or in which damage to property was in excess of one thousand five hundred dollars ($1,500) to any person involved OR if an accident results in damage to state or local government property in excess of four hundred dollars ($400). This report is required regardless of who was at fault and in addition to any report filed by an investigating officer.
Failure to file a personal crash report with the Tennessee Department of Safety and Homeland Security may result in the suspension of driver license and registrations or nonresident operating privileges of any person involved in a crash.
Your report must be submitted to the Department within twenty (20) days from the crash. You can satisfy this requirement by completing the reverse side of this from and mailing it to the Tennessee Department of Safety and Homeland Security, P.O. Box 945, Nashville, TN 37202. If you have any questions, please call
toll-free (866) 903-7357 or the Telecommunications Device for the Deaf (615) 532-2281.
Thank you for your cooperation.
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