FR-5A Form PDF Details

In the realm of vehicular accidents within South Carolina, the process of adhering to the state's financial responsibility requirements is both intricate and imperative. Central to this process is the Fr 5A form, a document issued by the South Carolina Department of Motor Vehicles (SCDMV), designed as a comprehensive response mechanism for individuals and insurance companies involved in road mishaps. This form functions in conjunction with Form FR5, or the Notice of Financial Responsibility Accident, allowing for a detailed submission of essential information including but not limited to the customer's name, date of the accident, suspension details, driver license number, and vehicle identification. Insurance companies play a pivotal role, as they are tasked with submitting verified insurance information either electronically or through direct submission, ensuring the coverage spans the date of the accident. Moreover, the Fr 5A form outlines alternative clearance options, offering flexibility through methods such as notarized release of liability, installment agreement filings, or posting a security deposit, each tailored to facilitate the resolution of claims for property damage or bodily injury. This document, embodying a crucial step towards substantiating financial responsibility post-accident, underscores the legal obligations of drivers and insurance entities, while also emphasizing the procedural avenues available to them for compliance and resolution. The form not only contributes to the administrative efficiency of the SCDMV but also serves as a vital tool in the broader context of vehicular accident management and resolution in South Carolina.

QuestionAnswer
Form NameFR-5A Form
Form Length1 pages
Fillable?Yes
Fillable fields19
Avg. time to fill out4 min 3 sec
Other namesscdmvonline, sc alir, Blythewood, NAIC

Form Preview Example

South Carolina Department of Motor Vehicles

Response to Financial Responsibility Accident

FR-5A

(REV. 6/13)

NOTE: If Notice of Financial Responsibility Accident (Form FR5) is not included with this response, please include all information in this section as listed on the FR5 form.

Customer Name:

FR5 Reference No:

Date of Accident:

Date of Suspension:

Customer No:

Driver License No:

Year/Make:

 

VIN

 

Tag No.

 

 

 

 

 

 

INSURANCE (to be completed by insurance company or agent)

Your agent or insurance company can electronically submit your insurance information to DMV using the following website: www.sc-alir.com or the insurance information below can be completed by your agent or insurance company and submitted to DMV. The effective dates must cover the date of the accident for the vehicle that was involved in the accident.

Name of Company:

NAIC Code:

 

 

Policy Number

 

Vehicle Coverage Effective -

FROM:

 

 

TO:

Signature of Authorized Rep:

 

 

 

 

 

 

Date Signed:

 

 

 

Telephone:

 

ALTERNATIVE CLEARANCE OPTION 1 - NOTARIZED RELEASE OF LIABILITY

You may submit a notarized release of liability from all persons who received property damage and/or bodily injury. You may do this by submitting a completed FR 202 or FR 202a if you are a minor. These forms can be downloaded from our website located at www.scdmvonline.COM

ALTERNATIVE CLEARANCE OPTION 2 - FILE AN INSTALLMENT AGREEMENT

You may file an installment agreement that sets forth all claims for property damage and/or bodily injury, stating the amount of settlement, dates of payments and notarized signatures of all parties making agreement. You may do this by submitting a completed FR 230. This form can be downloaded from our website located at www.scdmvonline.COM

ALTERNATIVE CLEARANCE OPTION 3 - POST A SECURITY DEPOSIT

You may post a security deposit with the Department in the amount on the other side of this notice which must be paid by cash, cashier's check or money order and made payable to SCDMV.

I certify that the information listed above is true to the best of my knowledge. I can be subject to criminal penalties if I deliberately provide false information.

Owner Signature

SC Driver License No

SC Department of Motor Vehicles Financial Responsibility Office/ATTN FR5 PO Box 1498

Blythewood, SC 29016-0040 (803) 896-5000

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Part no. 1 for filling in FR-5A

2. Once your current task is complete, take the next step – fill out all of these fields - ALTERNATIVE CLEARANCE OPTION, ALTERNATIVE CLEARANCE OPTION, ALTERNATIVE CLEARANCE OPTION, I certify that the information, Owner Signature, SC Department of Motor Vehicles, and SC Driver License No with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Completing section 2 in FR-5A

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