Claim On-Line
Please complete the form on the right.
Once completed please click on the submit button below.
We request that you complete the form clearly to process your claim. Fields marked with * must be complete.
If you call us, or when we call you back, it would save you time if you had the following information handy.
But don't worry if you can't answer all of the questions now, we can sort this out as your claim progresses.
- Have your address and contact phone numbers ready
- The date of your accident, or when you first noticed any symptoms from the accident
- Where the accident took place and some brief details of what happened
- If you saw your GP or Doctor ~ what were you told ?
- Did the police attended the accident ? do you have a contact no. or code ?
- Do you have any contact details of any people /organisations you believe were responsible for the accident/injuries ( eg. insurance company names, numbers or addresses)