Form Fr 309 PDF Details

In the realm of motor vehicle operations and legal requirements in South Carolina, the FR-309 & FR-21 Traffic Collision Report stands as a crucial document for drivers and vehicle owners who find themselves involved in accidents not investigated by law enforcement. This form serves a dual purpose: it acts as an initial report for traffic collisions that result in either property damage exceeding one thousand dollars, bodily injury, or death, and also plays a vital role in maintaining the financial responsibility of the vehicle owner as mandated by South Carolina Law 56-5-1270. The completion and prompt submission of this form to the South Carolina Department of Motor Vehicles (SCDMV), specifically to the Financial Responsibility sector, within 15 days of the incident, are essential for compliance. The form not only gathers detailed information about the collision, such as the date, time, location, and parties involved but also requires information regarding the vehicle insurance status at the time of the accident. Failure to submit this form within the stipulated timeframe may result in the suspension of the owner’s registration and/or driving privileges in the state. Furthermore, this form includes sections for insurance representatives to affirm the insurance coverage of the vehicle at the accident time, thereby ensuring that all financial responsibility requirements set by the state are duly met.

QuestionAnswer
Form NameForm Fr 309
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessc dmv accident report form, collision report form, fr309, fr309 form

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For office use only

__________________________

Sheet ______ofof_______sheet(s)sheet(s)

South Carolina Department of Motor Vehicles

 

FR-309 & FR-21

TRAFFIC COLLISION REPORT

FR-309

. 7/05)

Not Investigated by Law Enforcement

(Est. 6/05

 

According to South Carolina Law 56-5-1270, the driver or owner of a vehicle which is in any manner involved in an accident that is not investigated by law According to South Carolina Law 56-5-1270, the driver or owner of a vehicle which is in any manner involved in an accident that is not investigated by law enforcement that results in total property damages of one thousand dollars or more or in death of bodily injury, shall complete and send this form to South enforcement that results in total property damages of one thousand dollars or more or in death or bodily injury, shall complete and send this form to South Carolina Department of Motor Vehicles, Financial Responsibility, P.O. Box 1498, Blythewood, SC 29016-0040 within 15 days of the collision.

Carolina Department of Motor Vehicles, Financial Responsibility, P.O. Box 1498, Blythewood, SC 29016-0040 within 15 days of the collision.

Date of collision Day of Week Time

am am pm pm

County collision occurred

ON what street did it occur:

ATwhat intersection did it occur, if applicable (street name):

INwhat city or town did it occur:

Your Vehicle

Driver’s Full Name

 

 

Street

 

City

State

Zip Code

Circle Point of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Areas Damaged

Date of Birth

Sex

Race

Driver’s License Number

State

Home Phone

Work Phone

 

8

1

 

2

 

 

 

 

 

 

 

 

front

 

Make

VIN

 

 

 

Body

Year

Tag number

State

Legally Parked ? (circle one) Yes / No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

9

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s Name

 

 

Street

 

 

 

City

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

Type of Vehicle (circle one): 01- Auto

03- Sta. Wagon

05- TR. Tractor

07- Farm

 

09- School Bus

11- Motorcycle

 

 

 

 

Approximate Cost to

 

 

02- Bicycle

04- Panel-Pickup

06- Other Truck

08- Comm. Bus

10- Other Bus

12- Other: (Description)____________________________________

 

Repair: $___________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Vehicle or Pedestrian

Other Driver’s or Pedestrian’s Full Name

 

Street

 

City

State

Zip Code

Circle Point of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Areas Damaged

Date of Birth

Sex

Race

Driver’s License Number

State

Home Phone

Work Phone

 

8

1

 

2

front

Make

VIN

 

 

 

Body

Year

Tag number

State

Legally Parked ? (circle one) Yes / No

7

 

 

9

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s Name

 

 

Street

 

 

 

 

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Vehicle (circle one): 01- Auto

03- Sta. Wagon

05- TR. Tractor

07- Farm

 

09- School Bus

11- Motorcycle

 

 

Approximate Cost to

 

02- Bicycle

04- Panel-Pickup

06- Other Truck

08- Comm. Bus

10- Other Bus

12- Other: (Description)____________________________________

Repair: $___________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Damage to property other than vehicle (for example: fence, guardrail, mailbox, building, etc.)

Name of owner

Street

City

State

Zip Code

FR-21-309A

COMPLETE REVERSE SIDE ALSO

Check here if a Form SR-23, Fleet policy of 25 or more vehicles is on file with the Department covering your vehicle.

Check here if a certificate of self-insurance has been issued by the department covering your vehicle and indicate the certificate number ______________

Check here if liability insurance was not in effect for your vehicle to comply with South Carolina Statutory Requirements.

(If any of the above are applicable, disregard the below portion)

TO THE VEHICLE OWNER:

You are hereby required to return this form to the Department of Motor Vehicles, Financial Responsibility, P.O. Box 1498 Blythewood, SC 29016 with the below portion You are hereby required to return this form to the Department of Motor Vehicles, Financial Responsibility, P.O. Box 1498 Blythewood, SC 29016-0040 completed by an authorized agent or representative of your insurance company showing that on the date and time stated above when the motor vehicle was being

with the below portion completed by an authorized agent or representative of your insurance company showing that on the date and time stated above when operated, that it was an insured motor vehicle. If the Department within 15 days from the date accident does not receive this form, the owner’s registration and/or driving the motor vehicle was being operated, that it was an insured motor vehicle. If the Department does not receive this form within 15 days from the date of privileges in this state could be suspended.

the accident, the owner’s registration and/or driving privileges in this state could be suspended.

COMPANY

USE ONLY

FOR INSURANCE

REPRESENTATIVE

TO BE COMPLETED BY INSURANCE AGENCY, BROKER, OR OTHER INSURANCE COMPANY REPRESENTATIVE

I hereby affirm that to the best of my knowledge the policy described below was in effect covering the vehicle listed on the date and time as mentioned.

(Failure to complete all information below will result in refusal of this form)

________________________________________________________________

___________________________________________

Name of Insurance Company

Policy Number

FROM: ____________________________ TO: ____________________________________

___________________________________________

 

Policy Holder

The information as contained herin is based solely upon my knowledge and belief as a representative of the above insurance company and no warranty of liability is imputed to the above mentioned insurance company as I have listed herein.

____________________________________________________________________________________________

_________________________

Signature of Authorized Representative

Title

Phone Number

NAIC Code Number

*(If insurance agent or broker indicate corresponding company code number assigned by the South Carolina Department of Insurance, indicate whether agent, broker, etc.)

Return this form to: S.C. Department of Motor Vehicles, Form FR-309, Financial Responsibility, Box 1498, Blythewood, SC 29016-0040

Return this form to: S.C. Department of Motor Vehicles, Form FR-309/FR -21, Financial Responsibility, Box 1498, Blythewood, SC 29016-0040

FOR INSURANCE COMPANY REPRESENTATIVE USE ONLY

CODES

USE

APPROPRIATE

CODES IN

BLOCKS

PROVIDED

1

2

3

4

5

6

7

8

9

SEATING

M-Motorcycle B- Bicycle O – Other

U - Unknown P - Pedestrian

RESTRAINT/SAFETY DEVICE

00 – Not Used

11 – Shoulder Belt Only

12 – Lap Belt Only

13 – Shoulder & Lap Belt

21 – Child Safety Seat

88 - Other

INJURY

0 – No Injury

1 – Possible Injury

2– Injury/non-life threatening

3 – Injury/life threatening

4 – Death

VICTIMS

WITNESSES

Name

Taken To:

Name

Taken To:

Name

Taken To:

Name

Taken To:

Name

Taken To:

Name

Name

Name

AGE

SEX

VEHICLE

SEATING

SAFETY

INJURY

 

 

NUMBER

 

BELTS

 

 

 

 

 

 

 

Taken By:

Taken By:

Taken By:

Taken By:

Taken By:

Home Number

Work Number

Cell Number

Home Number

Work Number

Cell Number

Home Number

Work Number

Cell Number

 

 

 

NARRATIVE

Please describe how the collision happened. Include factors that may have contributed to the collision such as road conditions, weather conditions, terrain, etc.

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

______________________________________

THE PERSON MAKING THIS REPORT MUST SIGN HERE

X___________________________________________________________________________________________________________________________________________

Signature

Address

Date

Mail this report to: S.C. Department of Motor Vehicles, FR 309/FR-21, Financial Responsibility, Box 1498, Blythewood, SC 29016-0040

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traffic collision report completion process described (step 1)

2. Given that the previous segment is done, you're ready add the necessary specifics in Damage to property other than, Name of owner, FRA FR, Street, City, State, Zip Code, COMPLETE REVERSE SIDE ALSO, Check here if a Form SR Fleet, If any of the above are applicable, TO THE VEHICLE OWNER, You are hereby required to return, TO BE COMPLETED BY INSURANCE, I hereby affirm that to the best, and Y N A P M O C E C N A R U S N so you're able to move forward further.

traffic collision report completion process described (step 2)

As to Check here if a Form SR Fleet and Damage to property other than, make sure you get them right here. The two of these are viewed as the most significant ones in this page.

3. Completing AGE, VEHICLE NUMBER, SAFETY BELTS, Name, Taken To Taken By, Name, Taken To Taken By, Name, Taken To Taken By, Name Taken To Taken By, Name Taken To Taken By, Name Home Number, Name Home Number, Name Home Number, and Work Number is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

A way to complete traffic collision report stage 3

4. This next section requires some additional information. Ensure you complete all the necessary fields - Please describe how the collision, THE PERSON MAKING THIS REPORT MUST, E V I T A R R A N, Signature Address, Mail this report to SC Department, and Date - to proceed further in your process!

Filling in section 4 in traffic collision report

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