Form FR-5A: South Carolina Response to Financial Responsibility Accident

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

Fill in the FR5 Reference No, Date of Accident, Date of Suspension, Customer No, Driver's License No, Customer Name, Year/Make, VIN and Tag No.

The INSURANCE section is to be completed by the insurance company or agent.

Your agent or insurance company can electronically submit your insurance information to the DMV through this website: www.sc-alir.com or your agent or insurance company may complete the INSURANCE section and submit it to the DMV at SCDMV Financial Responsibility, PO Box 1498, Blythewood, SC 29016-0040.

The effective dates must cover the date of the accident for the vehicle that was involved in the accident.

Enter the Name of Company, NAIC Code, Policy Number, and the Vehicle Coverage Effective From and To.

The authorized rep signs on Signature of Authorized Rep, and the Date Signed and Telephone are entered.

Certify that the information listed is true to the best of your knowledge; you can be subject to criminal penalties if you deliberately provide false information.

Sign on Owner Signature and enter the SC Driver's License No.

You may submit a release of liability from all persons who received property damage and/or bodily injury by completing Release of Financial Responsibility (Form FR-202).

If you are a minor, have the Release on Behalf of a Minor (Form FR-202A) completed.

These forms can be downloaded from the website dmv.sc.gov.

You may file a Financial Responsibility Installment Agreement (Form FR-230) that sets forth all claims for property damage and/or bodily injury, stating the amount of settlement, dates of payments and signatures of all parties making agreement.

This form can be downloaded from the website dmv.sc.gov.

You may post a security deposit, which must be paid by cash, cashier's check, or money order and made payable to the SCDMV.

You may pay your security deposit by mail by sending payment to SCDMV Financial Responsibility, PO Box 1498, Blythewood, SC 29016-0040 (cash not accepted through the mail).

The branch office locations that can also accept security deposits in-person are Columbia - O'Neil Court, Florence, Fort Mill, Irmo-Ballentine, Ladson, Spartanburg - Southport.