CALL US: 800.562.0601

Services :: Automobile Incident Report

ATBE Automobile Fund Incident Report

Instructions: An authorized representative of an ATBE Covered Party is to use this form to report to ATBE, within 7 days of the Incident, an Incident involving a Member board owned or Covered Party operated Covered Automobile, as defined in the Coverage Agreement. Transmit with this form or immediately upon receipt, if after submission of this form, a copy of the official police accident report. Note that a Claim or Loss should be submitted separate from the Incident Report and pursuant to the Notice of AL Claim Procedure or Notice of APD Loss Procedure.  (NOT for use by potential claimants)

Complete the form below OR
download and print the form and return it and all documents to ATBE:

General Information




Board of Education Employee Involved in Incident










Yes    No



Yes    No



Yes    No

Board of Education Vehicle Involved in Incident





Claimant(s) or Potential Claimant(s)


Witness(es)


Description of Incident, including statement by board employee driver involved in the Incident


Separate from the description and statements above, provide a copy of the official police accident report. (Upload Supporting Documentation Below.)

Board of Education Contact Regarding this Incident






Upload Supporting Documentation

Note: Additional supporting documentation and/or photographs may be emailed directly to lhs@hestersellers.com.