Legal Claims
Customers are required to answer all six questions below before completing the Claims Form. You will not be able to complete the Claims Form without answering the questions below.
On a SEPTA vehicle/Involved with a SEPTA vehicle On SEPTA property other than vehicle
Please complete all sections of this form that are relevant to your claim to the best of your knowledge.
Claimant Information
Male Female Trans Other
Incident Information
Please provide us with as much information pertaining to the incident as possible
Bodily Injury Property Damage Both
SEPTA Vehicle Information
If your incident involved a SEPTA vehicle (Bus, Trolley, Train, etc. please complete this section (Questions are designed for us to locate you on our Vehicle Cameras)
(Please check the appropriate box to indicate your position on the SEPTA vehicle at the time of the incident)
Boarding Exiting Sitting Standing
Window Aisle Sideway Facing Section
Driver Side Door Side
Front Behind
Moving Stopped
SEPTA Employee Information
Please complete the section that is relevant to you
If Employee Details are KNOWN
If Employee Details are NOT KNOWN please provide description
Male Female Trans Other
Bodily Injury Details
Were you injured? if so, please complete this section
Left Right Both
Yes No
Yes No
Property Damage Details
Has your property been damaged? If so, please complete this section
Yes No
Yes No
Yes No
Yes No
SEPTA Premises Information
If your incident happened on our Premises, please complete this section
Ice/Snow Dirt/Debris/Liquid Defect Other
Yes No
Yes No
Employment Information
Claims Summary Information
Please describe the Accident/Incident as fully as possible in your own words
Confirm