Personal Injury Compensation Claim Form - ClaimLine.co.uk
home
Call now on 0845 967 5801
No Win No Fee Claims
Contact us now for specialist no win no fee compensation claims advice. We'll even Call You Back
 

Personal Injury Compensation Claim Form

Compensation Claim Form - Making a personal injury compensation claim with ClaimLine’s help is quick, easy and financially risk free. Although many UK accidents result in claims against the persons or organisations responsible, it is essential that those claiming compensation seek qualified and experienced legal assistance. If you don’t, you may not be awarded your full entitlement. You could even lose your claim completely!

In order to assess the strength of your claim and the compensation you may receive, please complete our preliminary compensation claim form below or call ClaimLine on 0845 260 54 55. One of our experts will then assess your case.

Personal Details
Title:
First name(s):
*Surname:
Date of birth (dd/mm/yyyy):
*Address 1:
Address 2:
*Town/City:
County:
*Post code:
*Home telephone:
Work telephone:
Mobile telephone:
*E-mail address:

Accident/Incident Details
*Type of accident /incident:
*Date of accident /incident:
*Description of accident/incident:
Give details of any witnesses:
Details of who you believe is responsible:

Injury Details
*Description of injuries sustained in the accident /incident:
Did you visit your doctor:
Did you visit hospital:

Other Relevant Information
Other information you feel would be useful to us:
 

 

* - To help us assess your claim fields marked * must be completed.

The information you submit to ClaimLine will be kept strictly confidential and will only be used to make a preliminary assessment of your claim for injury compensation.

If you have any further questions please contact us at info@claimline.co.uk. We look forward to hearing from you.

Back to top

 

 

 
site map ¦ contact us ¦ disclaimer ¦ media ¦ partnerships
  ©2007 ClaimLine UK