To make an 'Obligation Free' claim enquiry please complete the form below...
or call us free on 0800 068 3821

To help us speed up the process in dealing with your enquiries it would be beneficial if you could provide as much detail as possible with regard to both the incident and the injuries. If it is possible to provide us with a contact telephone number we will be able to contact you at our earliest opportunity should we need any other information that would help further your claim for compensation.

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Please note: If you are referring a friend, please input your details in the fields near the bottom of the page and not in the fields immediately below. thank you.

Title*
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Fore Names*

Surname*

Address*

Postcode

Telephone Number*

Mobile Number

E-Mail Address (please ensure that your email address has been input correctly) *

Type of Accident*
Road Traffic Accident Slip, Trip or Fall Accident at Work Public Liability Claim Criminal Injury Accident Abroad Not Sure... Please Advise
Date of Accident*

Exact Location of Accident (please be specific)*

Details of Accident (please be specific)*

Details of Injuries*

Is this injury claim for you or are you referring a friend?
Please Select This is my own injury claim I am referring a friend
Please tick if you wish to claim your cashback or referral fee.*

If you are referring a friend please complete the following section.

Name

Address

Telephone Number

E-Mail Address

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Before submitting your Online Claim Form please read the Claim Form Terms and Conditions.

I confirm that I have read and understood the Claim Form Terms and Conditions*

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