Event data recorder information release sample

Event Data Recorder Information Release Claim Number Date of Loss Vehicle Year, Make, Model VIN Company I, _________________________________, am the owner of the above noted vehicle that was involved in a collision on the above noted date of loss. I hereby consent and authorize the representatives of the above noted company to access and download the information from the event data recorder located in my vehicle. The information recovered shall consist of, but is not limited to, pre-crash vehicle speed, driver brake and steering actions, airbag deployment status, seatbelt status, delta-v (the change in the vehicle’s velocity over time), throttle position and other data relevant to collisions the vehicle has been involved in. I understand that the information retrieved from the event data recorder may reveal information that is consistent or inconsistent with my recollection of the facts surrounding the collision on the above noted date of loss. I have read and understand the above information release. ________________________ Owner of Vehicle (Signature) ________________________ Date (Day, Month, Year)