Get Community Transit Standard Claim Form

Completing the Community Transit Standard Claim Form online can streamline your claim process and ensure your information is submitted accurately. This guide provides clear instructions to help you fill out each section of the form with confidence.

Follow the steps to complete your claim form online efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by providing your personal information. Enter your name in the designated fields for last name, first name, and middle name. Do not forget to include your date of birth in the format mm/dd/yyyy.
3. Next, fill in your residence address at the time of the incident and provide a different mailing address if applicable.
4. Include your daytime telephone number, making sure to indicate whether it is a home, cell, or business number. Additionally, provide your email address for any necessary correspondence regarding your claim.
5. In the incident information section, specify the date of the incident followed by the time (AM or PM). Make sure to double-check that all details are correct.
6. Provide the location of the incident, detailing the address, city, and county where it occurred.
7. List the names, addresses, and telephone numbers of all individuals involved or witnesses to the incident. You may attach additional sheets if required.
8. Document the names, addresses, and telephone numbers of all transit agency employees who are aware of the incident. Additional sheets can be included as needed.
9. Identify the transit agency alleged responsible for the damages or injury.
10. Describe the conduct and circumstances leading to the injury or damages in detail, including the extent of any medical, physical, or mental injuries. Attach extra sheets if necessary.
11. Provide the name, address, and telephone number of your treating physician(s) and attach copies of relevant medical reports and billing documents.
12. State the sum of damages you are claiming clearly in the designated space.
13. Ensure that the claimant or legal guardian signs the form, certifying under penalty of perjury that the information provided is accurate. Include the date and place of signing.
14. Once you have completed the form, save your changes. You can then download, print, or share the completed form as necessary.

Complete your Community Transit Standard Claim Form online today to efficiently file your claim.