CA DMV SR1 PDF Details

The main purpose of the SR-1 form is to ensure that all significant traffic accidents in California are reported to the DMV within 10 days if the accident involves any of the following:

- Injury or death of any person.

- Property damage exceeding $1,000.

Under California law, filing this form is a requirement regardless of fault. It must be completed in addition to any reports filed with law enforcement or insurance companies. The information helps maintain accurate DMV records and is used to assess financial responsibility. Failure to submit this report can lead to the suspension of driving privileges.

The California DMV SR-1 form also contains sections for detailed information about the vehicles, drivers, and any property or persons involved to help process claims and legal responsibilities following an accident.

QuestionAnswer
Form Name CA DMV SR1 Form
Form Length 3 pages
Fillable? Yes
Fillable fields 90
Avg. time to fill out 15 min
Other names DMV report accident, CA DMV SR1, DMV form SR 1, DMV accident report

Form Preview Example

STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES®

A Public Service Agency

Please type or print.

*SR1*

REPORT OF TRAFFIC ACCIDENT

OCCURRING IN CALIFORNIA

# OF VEHICLES

DATE OF ACCIDENT

ACCIDENT LOCATION (CITY/COUNTY) (CALIFORNIA ONLY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TIME OF ACCIDENT

AM

 

 

 

Stopped

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Moving

 

Parked

Pedestrian

Bicyclist

Other (E.G., ROLLAWAY)

INFORMATION

Hour

 

 

PM

in Traffic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S NAME (FIRST, MIDDLE, LAST)

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER LICENSE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S STREET ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

TELEPHONE NUMBERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PARTY’S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wk (

)

 

Hm (

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE (YEAR AND MAKE)

 

 

 

 

VEHICLE LICENSE PLATE OR VEHICLE IDENTIFICATION NUMBER

 

 

STATE

 

 

 

 

 

 

 

 

 

 

VEHICLE OWNER (PERSON OR COMPANY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REPORTING

ADDRESS

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

 

 

COMPANY NAIC NUMBER

 

POLICY PERIOD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY HOLDER NAME

 

 

 

 

 

 

 

 

From:

 

 

 

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Moving

Stopped in Traffic

 

Parked

 

 

 

Pedestrian

 

Bicyclist

Other (E.G., ROLLAWAY)

 

 

DRIVER’S NAME (FIRST, MIDDLE, LAST)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER LICENSE NUMBER

DRIVER’S STREET ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

 

TELEPHONE NUMBERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wk (

)

 

Hm (

PARTY’S

VEHICLE (YEAR AND MAKE)

 

 

 

 

VEHICLE LICENSE PLATE OR VEHICLE IDENTIFICATION NUMBER

 

 

STATE

 

VEHICLE OWNER (PERSON OR COMPANY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER

ADDRESS

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPANY NAIC NUMBER

 

POLICY PERIOD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY HOLDER NAME

 

 

 

 

 

 

 

 

From:

 

 

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ON PRIVATE PROPERTY

Yes No

DRIVING FOR EMPLOYER

Yes No

STATE

DATE OF BIRTH

)

DAMAGES OVER $1,000

Yes No

DATE OF BIRTH

ZIP CODE

DRIVING FOR EMPLOYER

Yes No

STATE

DATE OF BIRTH

)

DAMAGES OVER $1,000

Yes No

DATE OF BIRTH

ZIP CODE

INJURY/DEATH PROPERTY DAMAGE

NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED

OTHER PROPERTY DAMAGED (TELEPHONE POLES, FENCE, LIVESTOCK, ETC.)

PROPERTY OWNER’S NAME AND ADDRESS

Injured

 

Driver

Passenger

Deceased

 

Bicyclist

Pedestrian

Injured

 

Driver

Passenger

Deceased

 

Bicyclist

Pedestrian

 

DAMAGES OVER $1,000

 

 

Yes

 

No

 

 

 

READ IMPORTANT INFORMATION ON BACK

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

DATE

PRINTED NAME

SIGNATURE

X

SR 1 (REV. 1/2017) WWW

ADDITIONAL INFORMATION ATTACHED

Print

Clear Form

A

YOUR

CALIFORNIA INSURANCE INFORMATION

 

DO NOT DETACH

DMV FILE NUMBER

The Department may send this part to the insurance company indicated. If not fully completed,

 

 

VEHICLE

 

 

it will be assumed you were not insured for the accident and your license will be suspended.

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF INSURANCE COMPANY (NOT AGENT OR

 

 

 

 

 

 

BROKER) THAT ISSUED THE LIABILITY POLICY

 

 

 

 

 

 

COVERING THE OPERATION OF YOUR VEHICLE

 

 

 

 

 

 

POLICY NUMBER

 

POLICY PERIOD

 

 

 

 

 

 

 

 

 

From:

To:

 

 

I

 

 

 

DRIVER LICENSE NUMBER

 

 

 

 

 

 

 

 

 

 

(DRIVER OF YOUR VEHICLE)

N

DATE OF ACCIDENT

IN OR NEAR (CITY OR TOWN) (CALIFORNIA ONLY)

 

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

 

 

U

 

 

 

 

 

 

 

 

 

 

 

VEHICLE (YEAR AND MAKE)

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

VEHICLE LICENSE PLATE NUMBER

STATE

R

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

 

 

 

 

 

 

 

 

N

DRIVER

 

 

 

 

ADDRESS

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

OWNER

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FULL NAME OF POLICY HOLDER

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SR 1A (REV. 1/2017) WWW

If the policy was not in effect, this form must be completed and returned to DMV within 20 days.

The undersigned company advises that with respect to the reported accident, the policy reported on the reverse side:

WAS NOT IN EFFECT

 

 

 

 

 

 

Was not a liability policy

Did not cover the vehicle/driver

Number is not a company policy number

Policy Number

 

 

Policy Period from

 

to

 

Signature

 

 

 

MAIL TO:

 

 

 

 

 

 

 

Title

 

 

 

 

 

Department of Motor Vehicles

 

 

 

P.O. Box 942884

 

 

 

 

 

 

 

Date

Sacramento, CA 94284-0884

SR 1A (REV. 1/2017) WWW

IMPORTANT INFORMATION

California law requires traffic accidents on a California street/highway or private property to be reported to the Department of Motor Vehicles (DMV) within 10 days if there was an injury, death or property damage in excess of $1,000. Untimely reporting could result in DMV suspending a driver license. Accidents involving vehicles not required to be registered such as an off-road vehicle (OHV), implement of husbandry, or snowmobile or occurring on a military base or occurring on the driver’s own property involving only the personal property of the driver and there was no injury or death are not reportable.

The law requires the driver to file this SR 1 form with DMV regardless of fault. This report must be made in addition to any other report filed with a law enforcement agency, insurance company, or the California Highway Patrol (CHP) as their reports do not satisfy the filing requirement. An insurance agent, attorney, or other designated representative may file the report for the driver.

The law requires every driver and every owner of a motor vehicle to be “financially responsible” for any injury or damage resulting from operating or owning a motor vehicle. The minimum insurance level for “financial responsibility” is public liability and property damage coverage of $15,000 for injury or death of one person, $30,000 for injury or death of two or more persons and $5,000 property damage per accident. Comprehensive and collision insurance does not meet the legal requirement.

The California Vehicle Code (CVC) §1806 requires DMV to record accident information regardless of fault when individuals report accidents under the Financial Responsibility Law or if law enforcement agencies or CHP investigate and make a report.

WHEN COMPLETING THIS FORM...

Please print within the spaces and boxes on this form. If you need to provide additional information on a separate piece of paper(s) or you include a copy of any law enforcement agency report, please check the box to indicate ‘Additional Information Attached’. If you are the passenger reporting the accident, be sure to identify yourself by using the ‘other’ box and stating ‘passenger’ in the explanation.

•Write unk (for unknown) or none in any space or box when you do not have information on the other party involved.

•Give insurance information that is complete and which correctly and fully identifies the company that issued the policy.

•Place the correct National Association of Insurance Commissioners (NAIC) number for your insurance company in the boxes provided. The NAIC number should be located on your insurance ID card or you can contact your insurance agent or company for the information.

•Identify any person involved in the accident (driver, passenger, bicyclist, pedestrian, etc.) who you saw was injured or complained of bodily injury or know to be deceased.

•Record in the OTHER PROPERTY DAMAGED section any damage to telephone poles, fences, street signs, guard posts, trees, livestock, dogs, etc., meeting the filing requirement, including amount. This may require that you contact the owner of the property for an estimate of damages.

•Once you have completed this report, please mail it to:

Department of Motor Vehicles

Financial Responsibility

Mail Station J237

P.O. Box 942884

Sacramento, CA 94284-0884

DMV does not accept reports or take actions against non-reporting or uninsured motorists unless this SR 1 form is sent to DMV by someone involved in the accident or their designee and the report is received by DMV within one calendar year of the accident date.

ADVISORY STATEMENT

The accident information on the SR 1 is required under the authority of Divisions 6 and 7 of the CVC. Failure to provide the information will result in suspension of the driving privilege. Except as made confidential by law (e.g., medical information) or exempted under the Public Records Act, the information is a public record, is regularly used by law enforcement agencies and insurance companies, and is open to public inspection. CVC §16005 limits the public record for SR 1 reports to accident involvement, but does allow persons with a proper interest (involved drivers, their employers, etc.) to receive specified information. Individuals may inspect or obtain copies of information contained in their records during regular office hours. The Financial Responsibility Unit Manager, 2570 24th Street, Sacramento, CA 95818 (telephone number: 916-657-6677) is responsible for maintaining this information.

SR 1 (REV. 1/2017) WWW

How to Edit CA DMV SR1 Online for Free

When you're involved in a traffic accident in California that results in injury, death, or property damage exceeding $1,000, you must complete and submit the SR-1 form to the Department of Motor Vehicles. Here’s how to correctly fill out this document.

1. Accident Information

Start by entering the date and exact location of the accident, specifying the city or county within California. Indicate the number of vehicles involved and whether the accident occurred on private property. This section helps categorize the accident in DMV records.

sr 1 blanks to complete

2. Time and Nature of the Accident

Record the exact time of the accident and specify the conditions, such as whether the vehicle was moving, stopped, parked, or involved a pedestrian, bicyclist, or other situations like a rollaway.

3. Driver Information

For each driver involved, provide full names, driver's license numbers, and contact information, including street addresses and telephone numbers. Ensure you specify the state where each driver's license was issued.

Finishing sr 1 step 2

4. Vehicle Details

List each vehicle involved in the accident by year and make. Provide the vehicle license plate or identification number (VIN) and registration state. Check whether there was damage over $1,000.

Entering details in sr 1 part 3

5. Insurance Information

For each vehicle, enter the insurance company's name (not the agent or broker), policy number, and the National Association of Insurance Commissioners (NAIC) number. Specify the policy period from and to dates, ensuring the coverage was effective during the accident.

6. Injuries, Deaths, or Property Damage

Identify any individuals injured or deceased in the accident, providing their names and addresses. Describe the nature of their involvement (driver, passenger, bicyclist, pedestrian). If other property is damaged, describe the damage and provide the owner’s name and address.

Filling in sr 1 step 4

7. Additional Information and Signature

If additional information is necessary or a law enforcement report is included, check the box indicating that additional information is attached. The form must be signed and dated to certify that the provided information is correct and complete under penalty of perjury under California law.

8. Submission

Review the entire form for accuracy and completeness. Once filled out, mail the form to the DMV at the provided address. It's crucial to send this within 10 days of the accident to avoid penalties, such as suspending your driving privileges.

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