Auto Loss Form

Beginning November 1, 2026, Treasury requests will be available through the Treasurer’s Office Resources webpage. Submissions sent to Treasury email addresses will continue to be processed through January 15, 2027. For questions or assistance, contact A&FSupport@umassp.edu.

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Please fill out this form to report an automobile loss related to the University of Massachusetts.

Accident Information

Date of Loss

Accident Location

Description of Accident

Authority Contacted & Report Number

University Department Information

Department Name

Department Contact Person

Department Phone Number

University Driver Information

Driver's Full Name

Business Phone Number

Driver's License Number

University Vehicle Information

Year

Make

Model

VIN

License Plate Number

Describe Vehicle Damage

Other Vehicle Driver Involved (Optional)

Property Owner's Full Name

Property Owner's Address

Property Owner's Phone Number

Other Vehicle Information (Optional)

Year

Make

Model

VIN

License Plate Number

Describe Vehicle Damage

Injured Parties

Name, Address, Phone Number, & Injury Description

Name, Address, Phone Number, & Injury Description

Reporter's Name

Date Reported

Person Reported To

Additional Comments

Witnesses (Optional)

Name, Address, Phone Number

Name, Address, Phone Number

Email Address

If you would like a copy of this report, please enter your email address above.