Dd-Claim Form

Instructions - - Notice of Claim Form

Background Information This section must be completed by anyone who desires to make a claim against METRO. Please print personal contact information, including your name, date form was completed, address, phone number(s), and your city, state and zip code for mailing purposes. In addition, please print the date on which the claim occurred, the location, the time of day, visibility (i.e. light or dark), and the weather conditions at the time of the incident. Type of Claim: Auto-Vehicle The section must be completed if you have an automobile involved in an incident. Information regarding the year, make, color, model, and license plate number are required, along with the specific area(s) of damage. Please complete the portions relating to passengers and police report information (if known). Type of Claim: Bus Passenger The section must be completed if you were a bus passenger involved in an incident. Please print the bus number, route, and time of day. Also provide your boarding location and time, and exit location and time of day, along with the police report number, if known. Type of Claim: Train Passenger This section must be completed if you were a train passenger involved in an incident. Please print the required information beginning with the train number, time of day, the location where you boarded the train, and the time of day. Please include information on the location and time of day that you exited the train, and the police report number, if known. Type of Claim: Other This section must be completed if none of the above claim categories apply. Please specify what type of a claim you wish to make including all important information regarding the incident. Description of the Incident The  “Description  of  the  Incident”  section  must  be  completed  in  order  to  make  a  claim.  This  section  allows  you  to   give the facts describing the incident in your own words. Please include the names and contact information...