Tennessee Driver Form PDF Details

In Tennessee, following a vehicle crash involving injury, death, or property damage exceeding $400, individuals find themselves obligated to navigate the procedural landscape laid out by the Tennessee Department of Safety and Homeland Security. The Tennessee Owner/Driver Report form, identified officially as SF-0395 (Rev. 2/14), serves as a critical document in this process. The form solicits comprehensive information related to the crash, encompassing the date and location of the incident, details about the vehicle(s) involved—including make, year, and type—alongside personal information of the operator and owner such as names, addresses, and driver license details. It further probes into the presence of injuries or deaths due to the crash, estimates of vehicular damage, and queries about liability insurance coverage at the time of the accident. The completion and submission of this form to the Tennessee Department of Safety and Homeland Security within a twenty-day window are not only fundamental for compliance with the provisions of 55-12-104, T.C.A. but also essential in avoiding potential suspensions of driving privileges. Additionally, it facilitates the verification of insurance coverage, thereby underscoring its role in the broader administrative and legal aftermath of traffic incidents within the state. The significance of the Owner/Driver Report extends beyond mere record-keeping, as its timely and accurate completion can have lasting implications for all parties involved in the crash.

QuestionAnswer
Form NameTennessee Driver Form
Form Length2 pages
Fillable?Yes
Fillable fields51
Avg. time to fill out10 min 46 sec
Other namesowner driver report, tennessee accident report form, tennessee owner driver report, tennessee safety driver

Form Preview Example

TENNESSEE DEPARTMENT OF SAFETY

AND HOMELAND SECURITY

OWNER / DRIVER REPORT

IMPORTANT: COMPLETE FORM BELOW AND MAIL TO: TN DEPARTMENT OF SAFETY AND HOMELAND SECURITY P.O. BOX 945

NASHVILLE, TN 37202

DATE OF CRASH: _______________

PLACE OF CRASH: ______________________ __________________

(month/day/year)

(City)

(County)

VEHICLE MAKE _________________ VEHICLE YEAR __________ TYPE VEHICLE ________________________

NAME OF OPERATOR __________________________________________________ DOB ___________________

(Last)

(First)

(Middle)

ADDRESS ____________________________________________________________________ ZIP ____________

(Street)

(City)

(State)

DRIVER LICENSE NO: ___________________________ STATE ___________ EXPIRATION DATE ____________

NAME OF OWNER _____________________________________________________ DOB ___________________

(Last)

(First)

(Middle)

ADDRESS _____________________________________________________________________ ZIP ___________

(Street)

(City)

(State)

DRIVER LICENSE NO: ___________________________ STATE ___________ EXPIRATION DATE ____________

WERE THERE INJURIES OR DEATH INVOLVED IN THIS CRASH? ______ YES ______NO

DAMAGES TO YOUR VEHICLE: ____________________ LESS THAN $400 __________________ OVER $400.

IF OVER $400, ENTER AMOUNT _____________________.

IF AVAILABLE, LIST FOLLOWING INFORMATION ON OTHER DRIVER INVOLVED IN THIS CRASH:

___________________________________________________________________________________________

(Last Name)(First Name)(Middle Initial)(Driver License Number)

DID YOU HAVE LIABILITY INSURANCE COVERAGE FOR THIS CRASH? YES_______ NO ______

IF YES, PROVIDE COMPLETE INFORMATION BELOW:

NAME OF INSURANCE COMPANY (NOT AGENCY) __________________________________________________

ADDRESS ____________________________________________________________________ ZIP ____________

(Street)

(City)

(State)

POLICY NUMBER ____________________________ POLICY PERIOD: FROM ____________ TO ____________

NAME OF POLICYHOLDER ______________________________ ADDRESS ______________________________

NAME OF INSURANCE REPRESENTATIVE (AGENCY) WHO ISSUED POLICY ____________________________

ADDRESS ____________________________________________________________________ ZIP ____________

(Street)

(City)

(State)

NOTE: THE INSURANCE INFORMATION YOU PROVIDE WILL BE FORWARDED TO THE INSURANCE COMPANY FOR VERIFICATION.

____________________________________________ _____________________

(Signature)

(Date)

SF-0395 (Rev. 2/14)

TENNESSEE DEPARTMENT OF SAFETY AND HOMELAND SECURITY

OWNER / DRIVER REPORT

As set forth under the provisions of 55-12-104, T.C.A., you must file, or have filed in your behalf, a personal report with the Department of Safety, if you were involved in an automobile crash as an owner or driver involving death or injury, or in which damage to property was in excess of four hundred dollars ($400) to any person involved. This report is required regardless of who was at fault and in addition to any report filed by an investigating officer.

Failure to file a personal crash report with the Tennessee Department of Safety and Homeland Security may result in the suspension of driver license and registrations or nonresident operating privileges of any person involved in a crash.

Your report must be submitted to the Department within twenty (20) days from the crash. You can satisfy this requirement by completing the reverse side of this from and mailing it to the Tennessee Department of Safety and Homeland Security, P.O. Box 945, Nashville, TN 37202. If you have any questions, please call toll-free (866) 903-7357 or the Telecommunications Device for the Deaf (615) 532-2281.

Thank you for your cooperation.

TENNESSEE DEPARTMENT OF SAFETY AND HOMELAND SECURITY

SF-0395 (Rev. 2/14)

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file online accident report nashville tn spaces to fill in

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