Get 10 Plus 2 Form

The 10 Plus 2 Form is essential for applying for motor vehicle no-fault benefits under New York law. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to complete the 10 Plus 2 Form online seamlessly.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the date on which you are completing the form. This is the date you should use for your records.
3. Fill in the policy number associated with your motor vehicle insurance. This can typically be found on your insurance card.
4. Input the policyholder's name, ensuring you provide the full legal name as listed on the insurance documents.
5. Enter the date of the accident, following the format of month, day, and year.
6. Provide the claim number related to your accident. This number is crucial for identifying your claim with the insurer.
7. Fill in your name, phone numbers (home and business), and address, including street, city or town, and ZIP code.
8. Indicate your date of birth and social security number accurately for verification purposes.
9. Record the date and time of the accident, marking whether it was A.M. or P.M.
10. Describe the location of the accident, including the street name, city or town, and state.
11. Provide a brief description of what happened during the accident.
12. Describe your injury in as much detail as possible to assist with your claim.
13. Indicate if you were the driver, passenger, pedestrian, or a member of the policyholder’s household.
14. List the identity of the vehicle you occupied or operated at the time of the accident, including the owner’s name, make, and model.
15. Answer whether you were treated by any doctors or health service providers and provide their names and addresses.
16. If treated at a hospital, indicate whether you were an out-patient or in-patient and list the admission date.
17. Provide the total amount of health bills you have accrued so far.
18. Indicate if you lost time from work due to your injury, and specify the amount of time lost.
19. List your average work hours per week and daily, as well as your weekly earnings.
20. If applicable, detail other expenses incurred as a result of the accident.
21. Indicate if you were receiving unemployment benefits at the time of the accident.
22. Complete any necessary authorization sections for the insurer and sign and date the form at the end.
23. Finally, save the changes, download a copy, or print and share the form as needed.

Complete your 10 Plus 2 Form online today to ensure timely benefits!