[Kauai Police Department] TC vehicle vs vehicle

Minor Traffic Collision (two vehicles involved)

Was anyone involved in the collision injured or is reporting any injury?

Yes, there are injuries I want to report.

No, there are no injuries to report.

Important Notice:

If anyone was injured or is reporting an injury, this incident may not be reported online.

Please call our non-emergency line at (808) 241-1711 to file a report in person with an officer.

Do you have all of the following information for the other party involved in the collision? (Select “Yes” only if you have all of the below): Full name, Contact phone number, Insurance company name, Insurance policy number, Policy expiration date, Vehicle license plate number, Vehicle make, model, and color, Location of damage on the other vehicle.

Yes

Important Notice:

If you do not have all of this information this cannot be reported online. You will not be able to complete this submission without all of the required information.

Please call our non-emergency line at (808) 241-1711 to file a report in person with an officer.

Date and Approximate time of the collision

Circumstances of the collision

Driver Information (reporting party information)

Driver's License Information

Driver's License Number *

Issuing State / Country *

Expiration Date *

Phone Number

Do you have a US address?

Yes

No, I have an International address

International Address (if living outside of the US)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code / Zip

Country

Vehicle Information (reporting party)

Vehicle Type

Vehicle 1 Description

Make *

Model *

License Plate *

Additional information

Vehicle Year

Color

Number of Passengers

Vehicle Insurance Information

Policy Name *

Policy Number *

Expiration Date *

Are there any damages to report for this vehicle?

Yes

Please Mark the Areas of Damage

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Driver Information (other involved party)

Phone Number

Email (Optional)

Vehicle Information (other involved party)

Vehicle Type

Vehicle 2 Description

Make *

Model *

License Plate *

Additional information

Vehicle Year

Color

Number of Passengers

Vehicle Insurance Information

Policy Name *

Policy Number *

Expiration Date *

Are there any damages to report for this vehicle?

Yes

Please Mark the Areas of Damage

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Select a stroke width:

Upload file(s): photographs / insurance cards / etc.

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KPD online report number

Declaration

By submitting this report, I affirm that the information provided is true and accurate to the best of my knowledge. I understand that knowingly filing a false police report is a criminal offense.

Pursuant to Hawai‘i Revised Statutes §710-1015, filing a false report with law enforcement is a misdemeanor crime.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.