Motor Vehicle Accident Report

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Incident Report

Complete the form below. All fields marked with * are required.

Contact Information

Full Name *

Phone Number *

Email Address *

Accident Details

Date of Accident *

Borough *

Your Role in the Accident *

Driver

Passenger

Pedestrian

Did police respond to the scene? *

Yes

Brief Description *

Description of Injuries/Damages *

Did you exchange information with other vehicle? *

Yes

Upload Photos *

Click to upload or drag and drop

Scene photos, vehicle damage, exchange info (Required)

I understand this is not a police report and that I will be contacted regarding proper civil documentation and next steps.

Incident Submitted

Thank you. Your incident has been submitted successfully.

What Happens Next

A representative will contact you to assist with proper civil documentation
We will discuss your options and next steps
Guidance on MV-104 filing if applicable

Time limits may apply. New York law has specific deadlines for filing claims and required documentation. We will review your situation promptly.