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Personal Injury Compensation Claim Form

If you think you are entitled to make a personal injury claim please fill out the form below. One of our specialist consultants will phone you back to discuss your situation with you.

Your Details

First Name: *
Surname: *
House number or name: *
Postcode: *
Telephone: *
Alternative telephone:
Email address:
Accident / Incident details
Date of accident / incident:
 
Where and how your
accident / incident happened
and details of your injury     

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Contact us about your accident or injury
Call us for free on 0800 0 224 224 Call us from your mobile on 0330 123 123 0 (charged at local number and free when covered by inclusive minutes) Request a call back Text CLAIM to 82010 (standard network rates apply)