Chicago, IL · Cook County
Motor Vehicle Damage Claim Form
Chicago residents use this form to submit a claim for motor vehicle damage of $2,500 or less to the City Clerk’s Claims Department.
What this form is
Use this form to submit a claim for motor vehicle damage of $2,500 or less to the City of Chicago. It asks for claimant and vehicle details, insurance information, incident circumstances, and a signed certification. The form requires supporting documents, including a driver’s license or state ID copy, insurance card, and two itemized estimates or an itemized paid bill with proof of payment.
Who needs it
A person seeking compensation from the City of Chicago for motor vehicle damage of $2,500 or less should complete and submit this claim form.
How to submit it
Mail or hand deliver the completed form and required documentation to the Office of the City Clerk, City of Chicago, 121 North LaSalle Street, Room 107, Chicago, Illinois 60602, Attention: Claims Department.
About notarization
This document is signed and dated without a notary; the form requests supporting documents, but does not say any attachment or related step must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Chicago Motor Vehicle Damage Claim Form.
- 2
Complete The Claim
Print legibly and answer the required questions about yourself, your vehicle, insurance, and the incident.
- 3
Gather Supporting Documents
Attach the requested ID and insurance copies, estimates or paid bill and proof of payment, and any other supporting evidence required for your claim.
- 4
Submit To The City
Mail or hand deliver the form and required documentation to the City Clerk’s Claims Department at the address listed on the form.
Frequently asked questions
- Do I need a notary for the Motor Vehicle Damage Claim Form?
- No. The form is signed and dated without a notary. It requests supporting documents but does not say any attachment or related step must be notarized or sworn.
- How do I submit the Motor Vehicle Damage Claim Form?
- Mail or hand deliver the completed form and required documentation to the Office of the City Clerk, City of Chicago, 121 North LaSalle Street, Room 107, Chicago, Illinois 60602, Attention: Claims Department.
- What supporting documents does the claim form request?
- The form requests a copy of your driver’s license or state ID and insurance card. It also calls for two written itemized estimates or an itemized paid bill with proof of payment. A subrogated demand letter is required if you filed an insurance claim.
- When is a letter of experience from my insurer required?
- The form says a letter of experience from the insurance company must be provided for claims over $500.
Need something notarized?
This Motor Vehicle Damage Claim Form doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.