"Driver Exchange of Information Form" - Florida

Driver Exchange of Information Form is a legal document that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida.

Form Details:

  • The latest edition currently provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download "Driver Exchange of Information Form" - Florida

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Driver Exchange of Information
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF FLORIDA HIGHWAY PATROL
This form has been designed to assist all parties involved in making an incident report to their insurance
company.
DRIVER 1
Name 
    ____________________________________________________________________ 
Address 
       _________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     _______________ 
Business                              Home  
  Phone (_____)_______________        Phone (_____)________________ 
Driver License No. and State ____________________________________________ 
Vehicle Owner 
Name 
    ____________________________________________________________________ 
Address 
       __________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     _______________ 
Business                              Home  
  Phone (_____)_______________        Phone (_____)________________ 
Year and Make                       Tag No. and State 
of Automobile ___________________                    ____________________ 
Insurance                                      Policy No. 
  Company  ___________________________________           ________________ 
DRIVER 2
Name 
    ____________________________________________________________________ 
Address 
       _________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     _______________ 
Business Phone                        Home Phone 
              (_____)_______________             (_____)________________ 
Driver License No. and State ____________________________________________ 
Vehicle Owner 
Driver Exchange of Information
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF FLORIDA HIGHWAY PATROL
This form has been designed to assist all parties involved in making an incident report to their insurance
company.
DRIVER 1
Name 
    ____________________________________________________________________ 
Address 
       _________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     _______________ 
Business                              Home  
  Phone (_____)_______________        Phone (_____)________________ 
Driver License No. and State ____________________________________________ 
Vehicle Owner 
Name 
    ____________________________________________________________________ 
Address 
       __________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     _______________ 
Business                              Home  
  Phone (_____)_______________        Phone (_____)________________ 
Year and Make                       Tag No. and State 
of Automobile ___________________                    ____________________ 
Insurance                                      Policy No. 
  Company  ___________________________________           ________________ 
DRIVER 2
Name 
    ____________________________________________________________________ 
Address 
       _________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     _______________ 
Business Phone                        Home Phone 
              (_____)_______________             (_____)________________ 
Driver License No. and State ____________________________________________ 
Vehicle Owner 
Name 
    _____________________________________________________________________ 
Address 
       __________________________________________________________________ 
City                                  State          Zip 
    ________________________________        ________     ________________ 
Business                               Home 
   Phone    (_____)_________________   Phone  (_____)____________________ 
Year and Make                       Tag No. and State 
of Automobile ___________________                    ____________________ 
Insurance                                      Policy No. 
  Company  ___________________________________           ________________ 
ACCIDENT INFORMATION 
Location of Accident                          City/State 
Street                                                 
    ________________________________________    _________________________ 
                   Time                   Date 
                         _________________      ________________ 
WITNESS INFORMATION 
_______________________________________________________________________________ 
Name and Address
_______________________________________________________________________________ 
Name and Address
_______________________________________________________________________________ 
Name and Address
INVESTIGATING OFFICER 
Name:  _____________________________________________________________ 
Badge #  and Department: ___________________________________________ 
Was a Florida Traffic Accident Report completed by the Investigating Officer? Yes No 
Was a traffic citation issued by the Investigating Officer? Yes No
Remarks (Optional)  
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