Crash Reporting - Driver's Self Report (Alaska Form 12209)
The two buttons at the bottom of this page link to the forms necessary for you to report your crash. The first button is "Blank 12209 Form." The second button is "Certificate Of Insurance."
Which form do I need?
- Option 1
- Option 2
- The Certificate Of Insurance button downloads a blank certificate of insurance form (titled "Certificate of Insurance"). Select Option 2 if a law enforcement officer reported to the scene of the crash, conducted an investigation and provided you with a case number.
Whether you select options 1) or 2) you must print the form, fill it out, sign it and mail or fax it to:
- DMV Main Office
- P.O. Box 110221
- Juneau, Alaska 99811-0221
- Phone: (907) 465-4361
- Fax: (907) 465-5509
Be sure to make a copy for yourself and note the SR# (located in the upper right-hand corner of the first page).
Download 12209 Form
- Opens a blank PDF form for you to print and fill out by hand.
Certificate of Insurance
- The officer at the scene stated I need to fill out a Certificate of Insurance (DMV Form 466).
- Please note: If you are filling out a 12209 form (the option above) then the Certificate of Insurance form is not necessary.