Form Nf 2 – Fill Out and Use This PDF

Updated: Oct 29, 2026

The NF-2 form, also known as the Application for Motor Vehicle No-Fault Benefits, is a crucial document for individuals in New York seeking compensation under the No-Fault Insurance Law after a motor vehicle accident. It requires detailed information about the applicant, the accident, and any resulting injuries or losses to determine eligibility for benefits. Completing and returning this form promptly, along with any required authorizations and accompanying bills or receipts, is essential for timely processing.

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Form Nf 2 PDF Details

In the state of New York, individuals who find themselves in the aftermath of a motor vehicle accident have a crucial ally in the form of the New York Motor Vehicle No-Fault Insurance Law. This legislation not only simplifies the process of seeking compensation for accident-related expenses but also aims to ensure timely assistance. Central to this process is the New York State Form NF-2, an Application for Motor Vehicle No-Fault Benefits, which serves as a comprehensive tool for victims to initiate their claims. When completed, this form provides insurers with the necessary information to determine eligibility for no-fault benefits. Key sections of this form include personal identification details, specifics about the accident, and a detailed account of the injuries sustained. Additionally, it addresses the treatment received and any loss of earnings, thereby offering a thorough picture of the incident and its repercussions. It’s imperative for claimants to fill out the form accurately and provide any required documentation, such as bills for medical treatment and evidence of lost wages, to support their claim. Moreover, the form includes strict disclaimers regarding the submission of false information, underscoring the severity of insurance fraud. By signing the NF-2 form, applicants authorize the release of pertinent employment and medical treatment information, ensuring that insurers have access to all relevant data. This structured approach, mandated by the New York Comprehensive Motor Vehicle Insurance Reparations Act, significantly aids individuals in navigating the potentially complex post-accident landscape.

Question	Answer
Form Name	Form Nf 2
Form Length	3 pages
Fillable?	Yes
Fillable fields	85
Avg. time to fill out	45 sec
Other names	new york form nf2, motor vehicle no fault, ny no fault insurance law, ny form nf2

How to Fill Out Form NF-2

Form NF-2 at a glance

What it is: This form is the application for motor vehicle no-fault benefits under the New York motor vehicle no-fault insurance law.

Who signs: To be eligible for benefits you must complete and sign this application, and you must sign any attached authorization(s). If the applicant is a minor, a parent or guardian signs and indicates capacity and relationship.

A filled-in Form NF-2 example: a passenger applies after a taxi crash

Form NF-2 example filled out, example: a passenger applies after a taxi crash — Jane Sample applies for no-fault benefits on Form NF-2. She was a passenger in an automobile in a crash and was treated as an out-patient. The picture shows page 1 only, and every value in it is made up. She was not the driver, not a pedestrian, not in the policyholder's household and neither she nor a relative she lives with owns a motor vehicle. Box 13 is out-patient, so date of admission stays empty. She lost one week of work and has returned to work. She will not have more health treatment, and at the time of the accident she was not in the course of her employment. She has one employer, so the second and third employer rows stay empty.

How to fill out Form NF-2, box by box

Your name, phone nos. and address

Enter your name, your phone nos., home and business, your address (no., street, city or town and zip code), your date of birth and your social security no.

Boxes 6 to 9, the accident and your injury

In box 6, enter the date and time of the accident and mark A.M. or P.M.

In box 7, enter the place of accident (street), city or town and state; in box 8, enter a brief description of the accident.

In box 9, describe your injury.

Box 10, the vehicle you occupied or operated

In box 10, enter the owner's name, make and year of the vehicle you occupied or operated at the time of the accident.

Mark what this vehicle was: a bus or school bus, a truck, an automobile, or a motorcycle.

Box 11, driver, passenger or pedestrian

In box 11, mark yes or no for each of these: were you the driver of the motor vehicle, were you a passenger in the motor vehicle, were you a pedestrian, were you a member of the policyholder's household, and do you or a relative with whom you reside own a motor vehicle.

Boxes 12 and 13, doctors and hospital

In box 12, mark yes or no if you were treated by a doctor(s) or other person(s) furnishing health services; if yes, enter the name and address of such doctor(s) or person(s).

In box 13, if you were treated at a hospital(s), mark if you were an out-patient or an in-patient, and enter the date of admission and the hospital's name and address.

Boxes 14 to 16, health bills, more treatment and employment

In box 14, enter the amount of health bills to date; in box 15, mark yes or no if you will have more health treatment(s); in box 16, mark yes or no if, at the time of your accident, you were in the course of your employment.

Boxes 17 to 20, time lost, earnings and employers

In box 17, mark yes or no if you lost time from work, and enter the date absence from work began; mark yes or no if you have returned to work, and if yes, enter the date returned to work and the amount of time lost from work.

In box 18, enter your gross average weekly earnings, the number of days you work per week and the number of hours you work per day.

In box 19, mark yes or no if you were receiving unemployment benefits at the time of the accident.

In box 20, list the names and address of your employer and other employers for one year prior to accident date, and enter the occupation and dates of employment, from and to, for each employer.

Boxes 21 and 22, other expenses and other payments

In box 21, mark yes or no if, as a result of your injury, you have had any other expenses; if yes, attach explanation and amounts of such expenses.

In box 22, mark yes or no if, due to this accident, you have received or are eligible for payments under New York State disability and under workers' compensation.

Signing the application

The applicant enters the signature and date; this form is subscribed and affirmed by the applicant as true under the penalties of perjury.

If the applicant is a minor, a parent or guardian signs and indicates capacity and relationship.

The applicant authorizes the insurer to submit any and all of these forms to another party or insurer if such is necessary to perfect its rights of recovery provided for under the no-fault law.

Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim for any commercial or personal insurance benefits containing any materially false information commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the value of the subject motor vehicle or stated claim for each violation.

The authorization for release of work and other loss information

For the authorization for release of work and other loss information, enter your name (print or type) and social security no., then enter the signature and date.

The authorization for release of health service or treatment information

For the authorization for release of health service or treatment information, enter your name (print or type), then enter the signature and date.

More rules for Form NF-2

Complete this form and return it promptly, to determine if you are entitled to benefits under the New York no-fault law.

Return the application promptly with copies of any bills you have received to date.

Sources

[1] Form NF-2 (Rev 1/2004), Application for Motor Vehicle No-Fault Benefits, New York State Department of Financial Services (the Official source link on this page).