Get Blumberg Small Claims Form

Filling out the Blumberg Small Claims Form online can streamline your process of making a claim for injuries sustained in an automobile accident. This guide will walk you through each step to ensure you complete the form accurately and effectively.

Follow the steps to fill out the Blumberg Small Claims Form online:

1. Press the ‘Get Form’ button to access the Blumberg Small Claims Form and open it in your preferred editor.
2. Provide your personal information including your name, date of birth, address, and Social Security number. Ensure accuracy in these details as they are critical for your claim.
3. Indicate your employment status by checking the appropriate box for either employed or unemployed.
4. Fill out the details of the accident including the date, time, and place. Be specific about where the accident took place.
5. Mark your role in the accident by selecting the appropriate option: driver, passenger, pedestrian, bicyclist, or vehicle number.
6. For each vehicle involved (if applicable), enter the year, state, make, model, color, and license plate number. Verify that these details match your records.
7. Provide the owner, driver, and insurance information for each vehicle involved, including their addresses and insurance policy numbers.
8. Indicate if you are receiving Worker’s Compensation and provide the name of the insurance company, if applicable.
9. Describe the accident in detail, providing as much information as possible to support your claim.
10. List all individuals residing with you, and if necessary, attach additional pages for more names.
11. Indicate whether anyone living with you owns a vehicle, providing the owner's name and insurance details.
12. Fill out the section on witnesses to the accident, including names, addresses, and telephone numbers.
13. Select the reason for your application to the Motor Vehicle Accident Indemnification Corporation, checking relevant boxes.
14. Attach a copy of both sides of the police report, as this is essential for your claim.
15. After reviewing all entered information for accuracy, you can save your changes, download, print, or share the completed form as needed.

Start filling out your Blumberg Small Claims Form online today to ensure your claim is submitted accurately and on time.