Attachment B.pdf

This is a damage claim form (Form 2062) from the South Carolina Department of Transportation (SCDOT). The form is used to submit claims for damage to registered vehicles or personal injury claims against SCDOT. The form requires claimants to provide detailed information including personal/business contact details, vehicle information, insurance information, and incident details. Two repair estimates or paid invoices must be submitted with the claim form, and all signatures must be notarized.

The form includes fields for documenting the amount claimed for both personal injury and property damage, requires description of the incident including cause and type of damage, and must include witness information. The bottom portion contains an affidavit section that must be completed by a notary public, where the claimant swears under oath that the claim is true and that no compensation has been received from other sources for the damages claimed. The final section is reserved for SCDOT use only, where claim approval/disapproval and amount decisions are recorded.