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If yes what is the name and address of the owner?
If you were driving your car please list the name and address of your auto insurance carrier you have:
If you were driving someone else's car please list the name and address of the vehicle’s auto insurance carrier:
If you were a passenger: Who was the owner (s) of the car and who is their automobile insurance carrier?
If you were a pedestrian: Who is the owner of the car that hit you?
If yes, please give name, address and phone: