Alaska Driver Self Report of a Motor Vehicle Crash

Crash Form Instructions

  • Please note: This application does not work for everyone’s browser. If you are receiving alert messages, please fill out a hardcopy of the form found here (this form contains an automatically generated SR Number). Sign and mail to DMV to:

    DMV Main Office
    P.O. Box 110221
    Juneau, AK 99811-0221

  • This is NOT an on-line submission of a crash report to DMV, that facility does not exist.

  • This application allows the user to fill out various form fields and generate a proper crash form. Upon completion, you MUST print, sign and mail the completed form to the DMV. You must have the ability to either print the generated form or save the file for printing later. After completing the entire form you will be presented with a final version in Adobe PDF format.

  • Your browser session will time out after a period of inactivity. If this happens then you will be required to begin again.

  • Mail signed form to (this address is also on the completed form):

    DMV Main Office
    P.O. Box 110221
    Juneau, AK 99811-0221

Go to the 12-209 entry application


     Online Certificate of Insurance Instructions

  • Fill out this form only if the police have investigated your crash and you were instructed to complete a CERTIFICATE OF INSURANCE and send to the DMV.

  • Complete the form, print it, sign it and make a copy for your records.

  • Mail the signed certificate to the DMV (see address above)

Go to the online Certificate of Insurance form

Blank Form

  • If you experience problems with the online form or just wish to fill out a blank form you may print a blank form (this form contains an automatically generated SR Number)Download Adobe Reader

  • Inquiries or assistance regarding the SR number should be Directed to DOT&PF at:

  • Inquiries or assistance regarding filling out the form should be directed to DMV (907-465-4361).

  • Mail the original form to the address listed on page 2 of the form, which is the same as the address listed above. Please note that the DMV does not acknowledge receipt of crash forms, but they will contact you if they need further information.

  • You can email questions to: