1. (a) A person required by RSA 264:25 to report an accident shall submit form DSMV 400 to the division.

2. (b) A person required by RSA 264:25 to report an accident shall submit the following on form DSMV 400:

   1. (1) A statement as to the day, date and time of accident;

   2. (2) A description of the location of accident, including:

      1. a. Route number or street name;
      2. b. Nearest intersecting route number or street name; and
      3. c. City or town, and county;
   3. (3) The number of vehicles involved;
   4. (4) A statement as to whether police investigated at scene;

   5. (5) A statement as to identification of drivers, including:

      1. a. Their names;
      2. b. Their addresses;
      3. c. Their telephone numbers;
      4. d. Their license numbers, states where issued, and classifications;
      5. e. Their dates of birth; and
      6. f. Their sex;

   6. (6) A statement as to the identification of the owner of the vehicle driven by each driver, including:

      1. a. Their name;
      2. b. Their addresses; and
      3. c. Their telephone numbers;

   7. (7) A statement as to the identification and description of the vehicle of each owner, including:

      1. a. Its year of manufacture;
      2. b. Its make;
      3. c. Its plate number and state where issued;
      4. d. Its trailer plate number and state where issued, if applicable;
      5. e. Its vehicle identification number;
      6. f. A description of the extent of the damage and estimated cost of repair; and
      7. g. An indication as to whether the vehicle is a commercial motor vehicle;
   8. (8) A diagram of the accident;
   9. (9) A narrative description of accident;

   10. (10) Description of occupants and witnesses, including:

       1. a. Their names;
       2. b. Their addresses and phone numbers;
       3. c. Their ages;
       4. d. Their sex;
       5. e. An indication as to whether safety equipment was used;
       6. f. A statement as to the type and location of injury;
       7. g. An indication as to whether the individual was a vehicle occupant, bicyclist, or pedestrian;
       8. h. A statement as to the injured person's position in or on vehicle, motorcycle, bicycle, or snowmobile;
       9. i. A statement as to whether helmet was worn; and
       10. j. A statement as to whether the injured person was thrown from vehicle;

   11. (11) The following regarding the operator's insurance:

       1. a. The name of the company;
       2. b. The insured's agent;
       3. c. The insured's agent's address;
       4. d. The policy number; and
       5. e. The effective date of the policy;
   12. (12) A description of property, other than vehicle, damage;

   13. (13) A statement as to the details of the accident, including:

       1. a. The type of accident, such as:

          1. 1. Collision; or
          2. 2. Noncollision;
       2. b. A description of any object struck;
       3. c. The accident's location;
       4. d. A description of any traffic controls;
       5. e. A description of the road design;
       6. f. A statement as to the road surface condition;
       7. g. A description of the weather at the time of the accident;
       8. h. A description of the types of vehicles involved in the accident;
       9. i. A statement as to the directions in which the vehicles were traveling; and
       10. j. A statement as to the pre-accident action of vehicles, bicyclists, or pedestrians; and
   14. (14) The signature of the operator and the date of the report.

Source. #2250, eff 12-31-82; ss by #2946-a, eff 1-3-85; ss by #4451, eff 6-24-88; ss by #4844, eff 6-20-90; ss by #6249, INTERIM, eff 6-16-96, EXPIRES: 10-14-96; ss and moved by #6337, eff 9-25-96 (from Saf-C 207.02); ss by #8174, INTERIM, eff 9-25-04, EXPIRES: 3-24-05; ss by #8230-B, eff 12-17-04; ss by #10395-B, eff 8-15-13