Auto Accident Insurance Verification Please enable JavaScript in your browser to complete this form.Name of Injured person *Date of Birth *Motor Vehicle (MV) Insurance Holder: *(Farmer's, State Farm, Geico, etc.)MV Claim # *MV Claim Handler/Agent Name *MV Claim Handler/Agent Phone # *Address of MV Insurance Company *Accident Location *Date of Accident (Loss Date) *Home address of Injured person *Comment or MessageEmailSend