Form DDS-190 "Accident Report" - Georgia (United States)

Form DDS-190 is a Georgia Department of Driver Services form also known as the "Accident Report". The latest edition of the form was released in January 1, 2016 and is available for digital filing.

Download a PDF version of the Form DDS-190 down below or find it on Georgia Department of Driver Services Forms website.

ADVERTISEMENT

Download Form DDS-190 "Accident Report" - Georgia (United States)

923 times
Rate
(4.6 / 5) 45 votes
GEORGIA DEPARTMENT OF DRIVER SERVICES
SAFETY RESPONSIBILITY UNIT
P.O. BOX 80447 CONYERS, GEORGIA 30013
678-413-8400
ACCIDENT REPORT
PLEASE READ INSTRUCTIONS CAREFULLY!! THIS FORM MUST BE FILLED OUT COMPLETELY IN ORDER TO
AVOID FILLING OUT A SUPPLEMENTAL REPORT.
1. Answer all questions to the best of your knowledge. If unable to answer any questions write “not known”.
2. Print all names and addresses.
3. Sign the report in the space provided on the reverse side.
4. Report must be complete as to the exact names, birth dates, and driver’s license numbers.
5. Use a second report form or a sheet of plain paper of the same size to report additional vehicles, injured
persons, witnesses or any other information for which there is insufficient space.
DATE
PLACE WHERE ACCIDENT
OF ACCIDENT:_______________________
OCCURRED (CITY/COUNTY):______________________________
YOUR VEHICLE #1:
Year: ____________ Make: _______________ Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)
Driver Name:_________________________ Driver’s License #:__________________ Driver’s Birth Date _________
Address: ___________________________________________ City:___________________
Zip: _____________
Owner: _____________________________ Owner’s License #: __________________ Owner’s Birth Date: ________
Address: ___________________________________________ City:____________________
Zip: _____________
VEHICLE #2:
Year: __________ Make: ________________
Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)
Driver Name:__________________________ Driver’s License #: ________________ Driver’s Birth Date: _________
Address____________________________________________ City:___________________
Zip: _____________
Owner: _____________________________ Owner’s License #: _________________ Owner’s Birth Date: ________
Address: __________________________________________ City:______________________ Zip: _____________
VEHICLE #3:
Year: __________ Make: ________________
Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)
Driver Name:___________________________ Driver’s License #: _______________ Driver’s Birth Date: ________
Address___________________________________________ City:______________________ Zip: _____________
Owner: _______________________________ Owner’s License #: ______________ Owner’s Birth Date: _________
Address: __________________________________________ City:______________________ Zip: _____________
DDS-190 (rev 01/16)
GEORGIA DEPARTMENT OF DRIVER SERVICES
SAFETY RESPONSIBILITY UNIT
P.O. BOX 80447 CONYERS, GEORGIA 30013
678-413-8400
ACCIDENT REPORT
PLEASE READ INSTRUCTIONS CAREFULLY!! THIS FORM MUST BE FILLED OUT COMPLETELY IN ORDER TO
AVOID FILLING OUT A SUPPLEMENTAL REPORT.
1. Answer all questions to the best of your knowledge. If unable to answer any questions write “not known”.
2. Print all names and addresses.
3. Sign the report in the space provided on the reverse side.
4. Report must be complete as to the exact names, birth dates, and driver’s license numbers.
5. Use a second report form or a sheet of plain paper of the same size to report additional vehicles, injured
persons, witnesses or any other information for which there is insufficient space.
DATE
PLACE WHERE ACCIDENT
OF ACCIDENT:_______________________
OCCURRED (CITY/COUNTY):______________________________
YOUR VEHICLE #1:
Year: ____________ Make: _______________ Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)
Driver Name:_________________________ Driver’s License #:__________________ Driver’s Birth Date _________
Address: ___________________________________________ City:___________________
Zip: _____________
Owner: _____________________________ Owner’s License #: __________________ Owner’s Birth Date: ________
Address: ___________________________________________ City:____________________
Zip: _____________
VEHICLE #2:
Year: __________ Make: ________________
Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)
Driver Name:__________________________ Driver’s License #: ________________ Driver’s Birth Date: _________
Address____________________________________________ City:___________________
Zip: _____________
Owner: _____________________________ Owner’s License #: _________________ Owner’s Birth Date: ________
Address: __________________________________________ City:______________________ Zip: _____________
VEHICLE #3:
Year: __________ Make: ________________
Type: __________________ (Sedan, Truck, Taxi, Bus, etc.)
Driver Name:___________________________ Driver’s License #: _______________ Driver’s Birth Date: ________
Address___________________________________________ City:______________________ Zip: _____________
Owner: _______________________________ Owner’s License #: ______________ Owner’s Birth Date: _________
Address: __________________________________________ City:______________________ Zip: _____________
DDS-190 (rev 01/16)
COMPLETE BOTH SIDES OF THIS FORM
DAMAGE TO PROPERTY OTHER THAN VEHICLE: ____________________________________________________
NAME OF OBJECT:_________________________ NATURE OF DAMAGE: _________________________________
APPROX. REPAIR COST: $__________________
NAME AND ADDRESS OF OWNER OF DAMAGED PROPERTY: _________________________________________
______________________________________________________________________________________________
DESCRIBE WHAT HAPPENED. REFER TO VEHICLES BY NUMBER. IF MORE SPACE IS REQUIRED, USE
ANOTHER REPORT OR A SHEET OF PLAIN PAPER OF THE SAME SIZE.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
DDS-190 (rev 12/15)
ADVERTISEMENT
Page of 2