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Risk Management Office

claims@charlottenc.gov

600 East Fourth St. 10th Floor Charlotte, NC 28202

704-336-3301

Auto Liability Claim Form

Full Name

Full Address

Date and Time of Accident

Date Picker

Weather at time of incident

Was anyone injured?


Describe Your Vehicle

Estimate Amount

Upload estimate and/or photos

Click Here to Upload

Describe Other Vehicle

Other entity


Signature

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