CA DMV SR1 – Fill Out and Use This PDF

Enter the # of vehicles, the date of accident and the accident location (city/county) (California only), and mark Yes or No for on private property.

Enter the time of accident, the hour, mark AM or PM, and mark Moving, Stopped in Traffic, Parked, Pedestrian, Bicyclist or Other (E.G., ROLLAWAY).

If you are the passenger reporting the accident, be sure to identify yourself by using the 'other' box and stating 'passenger' in the explanation.

Enter the driver's name (first, middle, last), driver license number, state, driver's street address, date of birth, city, state, ZIP code and telephone numbers (Wk and Hm).

Mark Yes or No for driving for employer.

Enter the vehicle (year and make), vehicle license plate or vehicle identification number, state, and mark Yes or No for damages over $1,000. (checked October 30, 2026)

Enter the vehicle owner (person or company), date of birth, address, city, state and ZIP code.

Enter the insurance company name (not agent or broker) at the time of the accident, policy number, company NAIC number, policy period From and To, and policy holder name.

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.

Mark Moving, Stopped in Traffic, Parked, Pedestrian, Bicyclist or Other (E.G., ROLLAWAY), and Yes or No for driving for employer.

Enter the vehicle (year and make), state, vehicle license plate or vehicle identification number, and mark Yes or No for damages over $1,000. (checked October 30, 2026)

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

Enter the name and address of individual injured or deceased, and mark Injured or Deceased and Driver, Passenger, Bicyclist or Pedestrian.

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.

Enter the other property damaged (telephone poles, fence, livestock, etc.), the property owner's name and address, and mark Yes or No for damages over $1,000. (checked October 30, 2026)

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.

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

Enter the date and printed name, and sign on the signature line.

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'.

Once you have completed this report, please mail it to: Department of Motor Vehicles Insurance Unit 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.

SR 1 is the Report of Traffic Accident Occurring in California; please type or print it. 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.

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.