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The Indiana SR21 form, officially known as the Indiana Operator’s Proof of Insurance/Crash Report, plays a critical role in the aftermath of vehicular crashes within the state. This document, identified by the State Form 52441 and updated in February 2006, serves multiple crucial purposes. It not only acts as a formal declaration of insurance coverage at the time of an accident but also functions as a comprehensive accident report. Individuals involved in collisions that result in injury, death, or property damage valued at $1000 or more are mandated to complete and submit this form within ten days following the incident. The form requires detailed information, such as the date and time of the collision, vehicle descriptions, and personal data of all involved drivers. Additionally, it must include a report from the responding officer and, critically, the signature of the insurance agent, certifying that the driver was insured on the collision date. This certification is a key component, as the absence of an insurance agent’s signature implies that the driver was uninsured at the incident time. Compliance with this requirement is essential, for failure to accurately complete and timely submit the form can lead to severe legal repercussions, including the suspension or revocation of driving privileges and vehicle registration. The procedure outlined for filling out the form is designed to gather information crucial not only for the administration of the Safety Responsibility Law but also to aid in preventing future crashes, underscoring the form's importance beyond mere bureaucratic necessity.

Sample - Indiana Sr21 Form

INDIANA OPERATOR’S PROOF OF INSURANCE/CRASH REPORT

STATE FORM 52441 (R / 2-06) / SR21

Collision Date

 

Day of Week

Actual Local Time

AM

# of Vehicles

Reporting Officer Name

 

Badge #

Send form to Bureau

MONTH

DAY

 

YEAR

 

 

 

 

PM

 

 

 

 

 

 

of Motor Vehicles.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do not send to

County where crash occurred

 

Nearest City/Town

Was Officer Report

Reporting Police Agency Name

 

 

Indiana State Police.

 

 

 

 

 

 

 

 

Taken?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Road Collision Occurred On:

 

Nearest Intersecting Road:

 

Direction and distance to nearest intersection:

Local ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Insured

Print Driver’s Name (Last, First, MI)

 

 

 

Driver’s License Number

 

 

 

 

 

 

 

 

 

 

 

 

Address (Number, Street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

State

 

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

 

 

 

DATE OF BIRTH

 

License Type

 

License State

 

Month

 

Day

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Owner’s Name & Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Veh. Yr.

 

Make

Model

 

Lic. Yr.

Lic. Plate #

Lic. State

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Drivers Involved

Print Driver’s Name (Last, First, MI)

Driver’s License Number

Sex

 

DATE OF BIRTH

 

 

Month

Day

Year

 

 

 

 

 

Print Driver’s Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

Driver’s License Number

Sex

 

DATE OF BIRTH

 

 

Month

Day

Year

 

 

 

 

 

Print Driver’s Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

Driver’s License Number

Sex

 

DATE OF BIRTH

 

 

Month

Day

Year

 

 

 

 

 

Name of Person Submitting This Report

Date Signed

Signature

THIS SECTION MUST CONTAIN THE SIGNATURE OF YOUR INSURANCE AGENT, IF YOU HAD INSURANCE AT THE TIME OF THE COLLISION. The company signatory hereto gives notice that its policy issued to the above named insured is a motor vehicle liability policy approved by the Commissioner of Insurance of the State of Indiana and was in effect on the date of the above described collision. A signature by an insurance agent or authorized representative is verification that the above driver (Insured) was insured at the time of the collision. Omission of agent signature signifies the driver was NOT insured at the time of the collision.

Insurance Company

Agency Name

Phone #

Date of Certification

Insured’s Policy Number

Signature of Authorized Insurance Representative

Date

Instructions for Completing the Indiana Operator’s Crash Report

Collisions resulting in injury, death or damage of $1000 or more (as determined by the reporting officer) must be reported on this form within 10 days. PRINT ALL INFORMATION USING ALL CAPITAL LETTERS (except your signature). Complete in black or blue INK.

Answer all questions to the best of your knowledge. If you are unable to answer any question, mark “unknown” or “U”. If the answer does not apply, mark with a slash (\) through the box.

YOU ARE THE INSURED. LIST THE DRIVER INFORMATION FOR ALL OTHER DRIVERS INVOLVED IN THE COLLISION UNDER “OTHER DRIVERS INVOLVED”.

If you were insured at the time of the collision, you must have the signature of the insurance agent before mailing the report.

Please submit this report to:

Bureau of Motor Vehicles

Important! PFR/Crash Report Section

Send to: P.O. Box 7169

Indianapolis, IN 46207

BY LAW, YOUR REPORT IS CONFIDENTIAL AND CANNOT BE USED AS EVIDENCE IN ANY TRIAL IC 9-26-3-4

The driver of any motor vehicle involved in a crash that results in injury or death or total property damage of $1000 or more must make a report on this form within ten

(10)days. The failure or refusal of any person to report a crash as required is cause for the suspension or revocation of the operator’s or chauffeur’s license and vehicle registration of such person. Such failure or refusal is also a misdemeanor. If the driver is physically incapable of making the report, any occupant of the vehicle is required to do so. A witness may also be required to make a report. A supplementary report will be required whenever an original report is insufficient.

The purpose of this report is to obtain information necessary to the administration of the Safety Responsibility Law and to obtain data useful in crash prevention. Complete and clear answers to all the questions are necessary. An accurate original report will avoid the necessity for supplementary reports. If you have difficulty in filling in the report, consult your nearest police authority or Bureau of Motor Vehicles at (317) 232-2840.

Form Overview

Fact Detail
Form Title Indiana Operator’s Proof of Insurance/Crash Report
Form Number State Form 52441 (R / 2-06) / SR21
Purpose To report collisions resulting in injury, death, or property damage of $1000 or more
Reporting Deadline Within 10 days of the collision
Submission Address Bureau of Motor Vehicles, PFR/Crash Report Section, P.O. Box 7169, Indianapolis, IN 46207
Governing Law Ind. Code § 9-26-3-4
Consequences of Failure to Report Suspension or revocation of driver's license and vehicle registration, possible misdemeanor charges

Guide to Filling Out Indiana Sr21

After being involved in a vehicular collision in Indiana that results in injury, death, or property damage of $1000 or more, drivers are required to complete the Indiana Operator’s Proof of Insurance/Crash Report, also known as form SR21. This document must be submitted to the Bureau of Motor Vehicles within ten days of the incident. The information provided will be used for administrative purposes and to gather data that can help prevent future crashes. It's important to fill out this form carefully and accurately to avoid the need for additional reports and to ensure compliance with Indiana law.

  1. Collect all necessary information regarding the crash, including the exact date, time, and location, as well as details about all vehicles and drivers involved.
  2. Print the form and prepare to fill it out with a black or blue ink pen, as required.
  3. Start by filling out the "Collision Date," "Day of Week," and "Actual Local Time" sections, specifying AM or PM as appropriate.
  4. Enter the "Number of Vehicles" involved in the collision.
  5. Provide the "Reporting Officer Name" and "Badge #" if a report was taken by a police officer at the scene. If not, leave this section blank.
  6. Fill in the address where the crash occurred, including "Nearest City/Town," "Road Collision Occurred On," "Nearest Intersecting Road," and the "Direction and distance to nearest intersection."
  7. Under "Insured Print Driver’s Name," enter the driver's name (last, first, middle initial), driver's license number, address, city, state, ZIP code, sex, and date of birth.
  8. For "License Type" and "License State," provide the relevant details of the driver's license.
  9. Fill in the "Print Owner’s Name & Address" section with the vehicle owner’s name (if different from the driver) and address.
  10. Document the vehicle details such as "Veh. Yr.," "Make," "Model," "Lic. Yr.," "Lic. Plate #," and "Lic. State."
  11. In the "Other Drivers Involved" section, list the names, driver's license numbers, sex, and dates of birth for all other drivers involved in the collision. Repeat this step for each driver involved.
  12. Complete the "Name of Person Submitting This Report," "Date Signed," and "Signature" fields at the bottom of the form.
  13. If you were insured at the time of the collision, have your insurance agent fill out the "Insurance Company," "Agency Name," "Phone #," "Date of Certification," "Insured’s Policy Number," and "Signature of Authorized Insurance Representative" fields. The agent's signature confirms that you were insured at the time of the collision.
  14. Review the completed form for accuracy and completeness. Make sure all sections that apply to your situation are filled out. If certain information is unknown, mark it as "unknown" or "U." If a section does not apply, slash (\) through the box.
  15. Mail the completed SR21 form to the Bureau of Motor Vehicles, PFR/Crash Report Section, P.O. Box 7169, Indianapolis, IN 46207.

Ensuring that the SR21 form is filled out accurately and submitted on time is crucial for meeting legal requirements and aiding in the effective administration of road safety measures in Indiana.

Frequently Asked Questions

What is the Indiana SR21 Form?

The Indiana SR21 Form, officially known as the Indiana Operator’s Proof of Insurance/Crash Report, is a document that must be completed and submitted to the Bureau of Motor Vehicles (BMV) following a motor vehicle crash. This form serves as proof that the driver involved in the crash had the required insurance at the time of the incident and provides detailed information about the crash, including when and where it occurred, the vehicles involved, and the insurance details.

When is it necessary to complete and submit an SR21 Form?

An SR21 Form must be completed and submitted any time a vehicle crash occurs in Indiana resulting in injury, death, or property damage of $1,000 or more. The form must be filed within 10 days of the accident as per state requirements.

Who is responsible for completing the SR21 Form?

The driver of the vehicle involved in the crash is generally responsible for completing the SR21 Form. However, if the driver is physically incapable of doing so due to injuries, any occupant in the vehicle at the time of the crash or a witness may complete the form. Additionally, the form requires a signature from the insurance agent, verifying that the driver was insured at the time of the collision.

What information do you need to complete the form?

To complete the SR21 Form, you will need detailed information about the crash, including the date, time, and location, details of all vehicles and drivers involved in the crash, and insurance information. It is important to answer all questions with as much detail and accuracy as possible. If you are unsure about any information, you may mark it as "unknown."

How do you submit the SR21 Form?

The completed SR21 Form should be sent to the Bureau of Motor Vehicles, PFR/Crash Report Section, P.O. Box 7169, Indianapolis, IN 46207. Do not send it to the county where the crash occurred.

What happens if you fail to submit an SR21 Form?

Failing to submit an SR21 Form within the specified 10-day period could lead to the suspension or revocation of your driving privileges, as well as your vehicle's registration. Additionally, it could be considered a misdemeanor.

Can the SR21 Form be used as evidence in a trial?

By law, the information contained in the SR21 Form is confidential and cannot be used as evidence in any trial. The primary purpose of this form is to provide proof of insurance and gather information necessary for the administration of the Safety Responsibility Law and for crash prevention analysis.

What if you were not insured at the time of the crash?

If you were not insured at the time of the crash, it is crucial to report this fact on the SR21 Form. The absence of an insurance agent's signature on the form will indicate that the driver was not insured. It is a legal requirement to have minimum liability insurance, and driving without it may result in severe penalties.

What should you do if you need help completing the form?

If you require assistance completing the SR21 Form, you can consult your nearest police authority or contact the Bureau of Motor Vehicles at (317) 232-2840 for guidance.

Is it necessary to complete the SR21 Form if no one was injured in the crash?

Yes, as long as the property damage from the crash is estimated to be $1,000 or more, an SR21 Form must be completed and submitted, regardless of whether any injuries were sustained.

Common mistakes

Filling out the Indiana SR21 form, officially known as the Indiana Operator’s Proof of Insurance/Crash Report, is a critical step in the aftermath of a vehicle collision. Yet, individuals often make mistakes during this process, which can lead to delays or issues in the handling of the accident case. Understanding these common mistakes can help ensure that the form is filled out accurately and completely.

One frequent mistake is not using all capital letters for filling in the information, as requested in the instructions. This form requires that all information, except signatures, be printed in uppercase letters to improve readability and reduce the potential for errors during processing. Another common oversight is completing the form with an ink color other than black or blue. The requirement for these specific ink colors is meant to ensure that the form is legible when photocopied or scanned.

Many individuals also neglect to answer every question, leaving certain fields blank. If the question does not apply or if the answer is unknown, it is essential to mark it with a slash (\) or write "U" for "unknown," instead of leaving it empty. This mistake can cause confusion and potentially delay the review process.

Another area where errors frequently occur is in the section that requires the signature of the insurance agent. This signature is crucial as it verifies that the driver was insured at the time of the collision. Failure to obtain this signature, when applicable, incorrectly signifies that the driver was not insured, leading to potential legal and financial complications.

The form also often gets sent to the incorrect address. It is explicitly stated that it should be forwarded to the Bureau of Motor Vehicles, not the county where the crash occurred. Misrouting the form can result in significant delays.

Furthermore, the accuracy of the information provided is another common pitfall. Mistakes in the driver’s license number, insurance policy number, or vehicle details can lead to the misidentification of involved parties or insurance coverage, complicating the post-accident proceedings.

Lastly, failure to comply with the time frame set for reporting the collision — within ten days if it resulted in injury, death, or property damage of $1000 or more — is a frequent error. Late submissions can lead to the suspension or revocation of the driver’s license and vehicle registration, as well as legal misdemeanors.

To avoid these common mistakes:

  1. Ensure all information is written in capital letters using black or blue ink.
  2. Complete every field, using a slash (\) or "U" for questions that do not apply or whose answers are unknown.
  3. Obtain the necessary insurance agent signature before mailing.
  4. Double-check that the form is sent to the correct address.
  5. Review all entered information for accuracy.
  6. Submit the form within the specified ten-day period following the collision.

By paying close attention to these guidelines, individuals can navigate the reporting process more smoothly and avoid complications arising from incorrectly filled-out forms.

Documents used along the form

When dealing with the aftermath of a motor vehicle accident in Indiana, the Indiana SR21 form is a key document, helping to establish proof of insurance as it pertains to the accident. However, to navigate through the legal and procedural steps efficiently, other forms and documents are often required in addition to the SR21. These documents play critical roles at different stages of the process, ensuring all necessary details and compliance requirements are met. Let’s explore some of these essential forms and documents.

  • Police Report: This is an official report filed by the officer who investigates the scene of the accident. It includes detailed information about the accident, including the parties involved, the conditions at the time of the accident, and a preliminary assessment of fault. It is crucial for insurance claims and legal proceedings.
  • Vehicle Registration Documents: These documents prove the ownership of the vehicles involved in the crash. They are necessary for identification purposes and must be presented to law enforcement and insurance companies.
  • Driver’s License: A valid driver's license is required to establish the identity of the drivers involved in the accident. It may also be checked for any restrictions or endorsements that could be relevant to the accident or insurance claims.
  • Insurance Policy: Beyond the proof of insurance provided by the SR21 form, the detailed insurance policy document may be required. This document outlines the coverage, limits, and any exclusions that might affect the claims process.
  • Witness Statements: If there were witnesses to the accident, their written statements or contact information might be collected. These statements can provide additional perspectives on how the accident occurred, which can be vital during insurance claims or legal action.

Gathering and managing these documents promptly after an accident is crucial. Together with the SR21 form, they form a comprehensive packet of information that supports your case in claims or legal matters. It's always advised to keep multiple copies and digital back-ups of these documents to prevent any delays or issues in processing your claims or legal proceedings. Accidents are stressful, but having the right documentation ready can make the recovery and resolution process much smoother.

Similar forms

The Indiana SR21 form is similar to the FR-10 and SR-22 forms, which are used in other states for similar purposes. Each of these forms serves as a confirmation of insurance coverage following a vehicular incident, but they differ slightly in terms of their specific requirements and uses within the legal framework of their respective states.

The FR-10 form, found primarily in South Carolina, is a close equivalent to Indiana's SR21 form. Like the SR21, it is required to be filed with the state's Department of Motor Vehicles (DMV) following a car accident. The FR-10 form is used by law enforcement to verify that the involved parties have the minimum required auto insurance coverage. Its primary function is to provide official documentation of insurance coverage at the time of the accident. The key similarity lies in its role in facilitating the process to ensure that drivers abide by the state's financial responsibility laws.

Another document that resembles the Indiana SR21 form is the SR-22 form, which is mandated by many states for drivers who need to prove financial responsibility. Unlike the SR21, which is used primarily as a crash report document, the SR-22 is required for drivers who have had their licenses suspended or revoked due to driving violations such as DUIs, not providing proof of insurance, or other serious infractions. The SR-22 serves as a certificate of insurance that verifies the driver has the minimum required liability insurance. Both forms, however, are integral to the process of reinstating driving privileges in their respective states after a violation or accident has occurred.

Dos and Don'ts

When you're preparing to fill out the Indiana SR21 form, also known as the Indiana Operator's Proof of Insurance/Crash Report, you are dealing with a crucial piece of documentation. This form plays a significant role in the aftermath of a traffic collision, especially in reporting to the Bureau of Motor Vehicles (BMV). Here are essential dos and don’ts to guide you through the process:

Do:
  • Read the instructions carefully before you start filling out the form. This seems straightforward, but it's a step that can significantly influence the accuracy of the information you provide.
  • Use all capital letters for printing information, except for your signature, as specified in the form instructions. This helps ensure that the information is readable and processed correctly.
  • Fill the form out in black or blue ink. These colors are standard for official documentation and are easier to read and photocopy.
  • Answer all questions to the best of your knowledge. If you're unsure about certain details, marking them as “unknown” or “U” is preferable over leaving them blank.
  • Ensure that the insurance agent signs the form if you were insured at the time of the collision. This signature is a critical piece of the form that indicates your insurance status.
  • Maintain the confidentiality of the report as required by law. Remember, this report cannot be used as evidence in any trial, emphasizing its role in administrative processes.
Don't:
  • Send the form to the wrong address. It must be submitted to the Bureau of Motor Vehicles, P.O. Box 7169, Indianapolis, IN 46207, and not to any other address or the county where the crash occurred.
  • Leave sections incomplete. If a certain section doesn’t apply to your situation, mark it with a slash (\) through the box instead of leaving it blank.
  • Forget to list the driver information for all other drivers involved under the “Other Drivers Involved” section. This information is crucial for a comprehensive report.
  • Ignore the guidance to consult with police authorities or the Bureau of Motor Vehicles if you have difficulty filling out the report. Their assistance can be invaluable in ensuring the accuracy and completeness of the report.
  • Use any colors of ink other than black or blue for filling out the form. Other colors might not be acceptable or legible.
  • Delay beyond the 10-day reporting window after the collision. Timely submission is mandated by law and is critical for the consequent administrative processes.

Following these guidelines will help ensure that the process of completing the Indiana SR21 form is as smooth and error-free as possible, aiding both your legal compliance and the administrative efforts of the Bureau of Motor Vehicles.

Misconceptions

When it comes to understanding the SR21 form in Indiana, there are several common misconceptions that can cause confusion. Here are ten misconceptions explained to help clarify the purpose and requirements of this document.

  • The SR21 form is only for traffic accidents with severe injuries. This is not accurate. The SR21 form is necessary for any collision resulting in injury, death, or property damage of $1000 or more, not just severe injuries.
  • If you didn't cause the accident, you don't need to fill out an SR21 form. Regardless of fault, if you were involved in an accident that meets the above criteria, you are required to submit an SR021 form.
  • The SR21 form can be sent to the county where the crash occurred. This is incorrect. The form should be sent to the Bureau of Motor Vehicles, not to any county office.
  • It's okay to fill out the form in pencil. The instructions specify that all information must be completed in black or blue ink, not pencil.
  • You can leave sections blank if they don't apply to you. If a question on the form does not apply to your situation, you should mark it with a slash (\) through the box instead of leaving it blank.
  • You don't need to report the accident if it didn't happen on a public road. The form requires reporting of accidents that result in injury, death, or property damage of $1000 or more, regardless of where they occurred.
  • Any witness to the accident can sign the SR21 form. The signatory to the SR21 form must be the insurance agent, indicating that insurance coverage was in effect at the time of the collision. Witnesses do not sign this form.
  • The SR21 form is evidence for trial use. By law, the SR21 report is confidential and cannot be used as evidence in any trial.
  • If the driver is incapable of filling out the form, no report is needed. If the driver is physically unable to complete the report, any occupant of the vehicle at the time of the accident or an involved party must submit the form.
  • Submitting the SR21 form is optional. Failure or refusal to submit an SR21 form for an accident meeting the required criteria is cause for suspension or revocation of the operator’s license and can be considered a misdemeanor offense.

Understanding these misconceptions about the Indiana SR21 form is crucial for ensuring that you comply with state laws regarding motor vehicle accidents. It's always important to read the instructions carefully and ensure you are fulfilling your legal obligations if involved in a traffic collision.

Key takeaways

Filling out and using the Indiana SR21 form correctly and efficiently is crucial following a vehicle crash. Here are key takeaways to ensure that individuals understand its importance and know how to complete the form accurately.

  • Timely submission is critical. The Indiana Operator’s Proof of Insurance/Crash Report (SR21) must be filed within 10 days following a collision that results in injury, death, or property damage of $1000 or more. This timeframe helps facilitate prompt processing and assists in crash documentation and insurance verification.
  • Accuracy matters. All information provided on the form must be printed in all capitals, save for signatures, and filled out in black or blue ink. Ensuring accuracy and completeness avoids processing delays and the need for submitting supplementary reports.
  • Insurance verification is mandatory. The form serves as proof of insurance at the time of the collision. A section of the form requires the signature of the insurance agent or authorized representative, affirming that the driver was insured. Absence of this signature indicates lack of insurance, potentially leading to legal consequences.
  • Address all sections appropriately. If certain questions are not applicable or cannot be answered, marking them “unknown” or “U” is acceptable. Additionally, irrelevant sections can be crossed out with a slash (\), ensuring clarity in responses.
  • Mandatory for all involved. The responsibility to report rests with the driver of the vehicle involved in the crash. If the driver is incapacitated, other occupants of the vehicle or witnesses may be required to submit the report, emphasizing community responsibility in crash reporting.
  • Confidentiality is assured by law. Submitted reports are confidential and are protected from being used as evidence in any trial. This confidentiality is governed by Indiana Code IC 9-26-3-4, providing reassurance to those hesitant to submit a report due to fear of legal repercussions.
  • Legal implications for non-compliance. Failing to submit the SR21 form as required can lead to suspension or revocation of the driver’s license and vehicle registration, underscoring the legal obligation tied to this form. It's also categorized as a misdemeanor, showcasing the seriousness of fulfilling this responsibility.

Understanding and adhering to these key points when filling out the Indiana SR21 form not only complies with state regulations but also aids in the efficient handling of post-collision procedures. This ensures that all parties involved are accountable and that necessary actions towards resolution and documentation are taken properly.

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